Heart disease and racial disparities: Why heart disease is more common in Black patients and how to prevent it

Bryan Smith, MD, with a patient

Dr. Bryan Smith meets with a heart disease patient.

Heart disease — a term used to refer to any disease affecting the heart muscle or the blood vessels of the heart — affects more than 30 million Americans and is the leading cause of death for both men and women. Yet, Black Americans are 30% more likely to die from heart disease than white Americans. Let's look at risk factors and treatments for heart disease, as well as what everyone can do to prevent it and maintain their cardiovascular health.

What causes heart disease? Who is most at risk for heart disease?

A number of factors can lead to the development of heart disease. High blood pressure, high cholesterol, smoking, diabetes and obesity are among the most common. Specifically, the people who are most likely to develop heart disease are those who have poorly controlled risk factors, those who have a strong family history, or those who have a genetic predisposition.

Though anyone can develop heart disease, it is more prevalent in certain populations. For example, heart disease is the number one killer of women; one in three women will die of heart disease, which is more than from all forms of cancer combined. Heart disease is also more common in Black patients, Latinx patients and in patients of South Asian descent. The reason for the increased prevalence of heart disease in these populations is a combination of genetic, environmental and social factors. So, it’s important to continue to spread awareness about the risk factors, signs and symptoms of heart disease for all those who may be at risk.

How does heart disease affect certain ethnic groups?

To really understand how race can affect heart disease — or any disease — we have to define exactly what race is. Race is partially a person’s biological makeup that includes physical characteristics. But, more accurately, race is a social construct, one that defines where you live, how you live, with whom you interact, and what your belief system is. People of a similar race tend to live near each other, share certain behavioral characteristics, and have similar social exposures. Because of this, certain races may be at risk for developing heart disease, not only because of biological factors that put them at risk, but also because of the environment in which they live.

Why are heart disease and heart failure so common in Black patients?

Unfortunately, many of the risk factors that predispose patients to developing heart disease and heart failure are more common in Black patients. For example, Black patients are more likely to have high blood pressure, and it is often more advanced and diagnosed at an earlier age than other groups. Because of higher rates of other cardiovascular risk factors such as diabetes, smoking, obesity, physical inactivity and high blood pressure, Black patients endure a greater burden of heart disease and heart failure.

However, it is crucial to mention that Black people are also more likely to suffer from health inequities as a result of the social determinants of health. Both structural and social inequities, which cause increased stress and distrust in the medical system, a lack of nutritious food options (living in food deserts), and poor access to medical care have a direct link to the development of heart disease and heart failure. As sobering as this news is, many of these risk factors are modifiable. When these risks are properly addressed and treated, then we have the ability to reverse this trend.

Do heart failure treatments differ for Black patients than for other patient populations?

Right now, several great heart failure medications are available that improve survival and quality of life for all patients. These medications include beta-blockers, angiotensin converting enzyme (ACE) inhibitors, aldosterone receptor antagonists (a type of diuretic drug), and sacubitril-valsartan (known by the brand name Entresto). In addition, digoxin and diuretic medications can help to treat symptoms of heart failure and keep patients out of the hospital. Medical heart failure therapies work, and, when taken appropriately, these medications can help people get better.

Currently, we know that when Black patients are optimized on heart failure therapy and yet continue to have symptoms, they may receive additional benefit by taking hydralazine and isosorbide dinitrate, known by the brand name BiDil, which was FDA-approved for this specific patient population in 2005. The reason for this may be that Black patients have decreased availability of nitric oxide and may benefit from the blood vessel relaxation provided by BiDil. None of the other medications used to treat heart failure is gender or race-specific, but the future of heart failure treatments may be medication regimens that are tailored toward specific patient populations.

How to prevent heart disease

Yes, it’s possible to prevent heart disease. The key to heart disease prevention is to focus on managing your risk factors and “knowing your numbers.” That means having regular check-ups with your physician so that you know your blood pressure, cholesterol, blood sugar and body mass index or BMI. By doing this, you can be aware if or when your risk factors become concerning, and you can make an early intervention.

To keep your numbers in the healthy range, you need to do a few simple but important things every day, starting with being more physically active. Even small changes can significantly reduce your risk. The recommended amount of physical activity per week is 150 minutes, or 2.5 hours. If that seems overwhelming, start with 10 to 15 minutes per day and train yourself to make it part of your routine.

In terms of dietary changes, cutting back on your salt intake can have a significant effect on improving your blood pressure, especially in Black patients who may be more sensitive to salt. Focus on eating more fruits and vegetables, whole grains and lean proteins, such as chicken or fish, as well. And, finally, focus on maintaining a healthy body weight by balancing calorie intake with physical activity to reduce your risk of developing heart disease.

If heart failure runs in my family, when should I be taking steps to keep my heart healthy?

You should start today! The journey toward a healthy life can start with baby steps at first. It really comes down to making small lifestyle changes that you can stick to rather than large, unsustainable fixes. Family history can put you at risk for developing heart disease, but, in many cases, you have the power to rewrite history.

When should I see a primary care physician? When to see a cardiologist?

A primary care physician can help to manage your risk factors to reduce the possibility of developing heart disease. However, once you have a diagnosis of heart disease or if you have poorly controlled risk factors, such as dangerously-high blood pressure, it is important to see a cardiologist, if one is available to you. A cardiologist can help focus on the in-depth management of your cardiovascular health and can tailor therapy and medications specifically toward your disease process. A cardiologist can also refer you to a cardiology subspecialist, if needed, to help manage complex heart rhythm issues, advanced heart failure, heart valvular disease, or coronary artery disease. Overall, maintaining good cardiovascular health is about having a team of collaborative physicians who all have the same goal of advocating for you and empowering you to live the healthiest possible version of your life.
Bryan Smith, MD

Bryan Smith, MD

Bryan Smith, MD, is a board-certified cardiologist who treats patients with complex cardiovascular disease, and specializes in the medical management of advanced heart failure and heart transplant.  

Learn more about Dr. Smith
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