Why Are African-Americans at Greater Risk for Heart Disease?

African-Americans are at higher risk for heart disease, yet they're less likely to get the care they need.

Medically Reviewed by Louise Chang, MD on February 15, 2010
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Heart disease has haunted generations of Robin Drummond's family. "I have a family history of heart disease on both sides," says the 55-year-old African-American and resident of Hammond, La. "I've had uncles, aunts, and grandparents who've died from heart attacks and heart disease, and two of my mother's brothers died four months apart. One had a heart attack in church, and four months later, one had a heart attack in the post office."

When Drummond's father succumbed to heart disease at age 50, she was shaken. "Particularly when my dad died, I wanted to make sure that I was OK," she says. In 2002, she went to her doctor for testing and learned that her heart was mildly enlarged, placing her at risk for heart failure. Drummond, a registered dietitian, took strenuous measures to ward off trouble. But not all African-Americans are aware of the danger.

African-Americans and Heart Failure

In a startling 2009 study published in the New England Journal of Medicine, researchers found that African-Americans have a much higher incidence of heart failure than other races, and it develops at younger ages. Heart failure means that the heart isn't able to pump blood as well as it should.

Before age 50, African-Americans' heart failure rate is 20 times higher than that of whites, according to the study. Four risk factors are the strongest predictors of heart failure: high blood pressure (also called hypertension), chronic kidney disease, being overweight, and having low levels of HDL, the "good" cholesterol. Three-fourths of African-Americans who develop heart failure have high blood pressure by age 40.

African-Americans and Health Care

To prevent heart failure and other heart disease, it's crucial to treat risk factors successfully, says Anne L. Taylor, MD, a professor of medicine at New York Presbyterian Hospital and vice dean of academic affairs at Columbia University's College of Physicians and Surgeons. But, compared with their white peers, African-Americans often have less access to health care, she says. Not only are they less likely to visit a doctor and get routine screenings, but they're less likely to be referred to specialists.

"African-Americans with heart failure are more likely to be taken care of in a primary care practice," Taylor says, "even though the data would suggest that the best care -- the care that decreases hospitalizations and improves mortality rates -- happens in cardiologists' offices."

Further, some African-Americans "tend to see illness and disease as the main reason for health care, so you don't go to the physician for preventive medicine -- you go when you're sick," says Keith C. Ferdinand, MD, FACC, FAHA. Ferdinand is a clinical professor in the cardiology division at Emory University and chief science officer of the Association of Black Cardiologists. "When are you sick? When you have symptoms: chest pain, shortness of breath, swelling, dizziness. By the time people manifest the signs and symptoms of cardiovascular disease, they have already had that disease present for one, two, or even three decades."

Treating Heart Disease Risk Factors

Drummond's father, who had health insurance but not a physician he would go to on a regular basis, provides a cautionary tale about why African-Americans must maintain a consistent relationship with a good doctor who knows their medical history and provides preventive care, screenings, and referrals to specialists.

"He had a leaking valve, and it didn't get replaced as soon as it should have," Drummond says. "The doctor told us it should have been replaced six or seven years earlier. When he started having swelling in his legs and shortness of breath, that's when he went to the hospital." Doctors diagnosed the leaking valve and performed surgery, but "it was too late for him," Drummond says. He died a few weeks after his surgery.

Besides a strong family history, Drummond has other risk factors for heart disease. She was diagnosed with high blood pressure at age 28 and with type 2 diabetes about five years ago. After years of unsuccessfully trying to control her blood pressure with diet and exercise, she now takes medications.

She's under a doctor's regular care, and she stays fit and eats healthy foods. "I work hard. I go to the gym to help control my hypertension and diabetes. I take the meds, I watch my sodium intake, and I work at keeping my weight within normal range." So far, she says, she's avoided heart failure.

What to Ask Your Doctor About Heart Disease

High blood pressure is a major risk factor for heart failure. Work with your doctor to keep it in check by asking the following questions:

  • What is my risk for developing high blood pressure?
  • How can I limit my risk and help prevent it?
  • What are the symptoms?
  • What does my blood pressure reading actually mean?
  • Am I taking any medicines that make me more susceptible?
  • What medications are available if I have high blood pressure?
  • What are the benefits and side effects?
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Robin Drummond, Hammond, La.

Anne L. Taylor, MD, professor of medicine, New York Presbyterian Hospital; vice dean of academic affairs, Columbia University's College of Physicians and Surgeons.

Keith C. Ferdinand, MD, FACC, FAHA, clinical professor, cardiology division, Emory University; chief science officer, Association of Black Cardiologists.

Bibbins-Domingo, K. New England Journal of Medicine, March 19, 2009; vol 360: pp 1179-1190.

Taylor, A. MD (editor ), The African American Woman's Guide to a Healthy Heart, The Association of Black Cardiologists Women's Center.

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