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BANGOR, Maine — Heart disease is still the number one cause of death for Americans, and research shows that Black Americans are 54 percent more likely to die from heart disease when compared to white their white counterparts due to distinct risk factors like genetics and systemic disparities.
While many continue to recognize Black History Month, doctors also shed light on Heart Health Month, sharing the importance of living a healthy lifestyle that reduces risk factors that lead to heart disease and being informed about the factors create grave differences in heart health when analyzed by race.
“[African American’s] risk for having some type of heart disease is almost 60 percent over the age of 40, which is a lot higher than Caucasian populations,” Dr. Kristopher O’Connell said.
O’Connell practices family medicine at Northern Light Health in Hampden. He said he thinks it’s important to mention that a lack of education about heart disease and the signs that indicate that you’re experiencing a heart attack or suffering from some form of heart emergency plays a part in Black Americans being more likely to die from heart disease.
“One of the concerns that a lot of these studies—they talked about could be a variable—is education of what heart disease can look like in their body,” O’Connell said. “Forty percent of women over the age of 40, when asked what a first sign of a heart attack was, they didn’t label chest pain as one of them. So, I think that’s important to know. Certain things can be symptoms of having a heart attack or having some kind of cardiac event. Chest pain, shortness of breath, cold sweats, difficulty breathing, and nausea, vomiting even.”
O’Connell said knowing what to look for can help you better alert someone when you’re experiencing a heart health emergency. Due to the way signs of heart disease show up differently from person to person, O’Connell and Dr. Pius Osei-Bagyina, who practices internal medicine at Northern Light Eastern Maine Medical Center, both said some people don’t get that lucky.
“It could not show any symptoms,” Osei Bagyina said. “And that’s the scary part.”
Osei-Bagyina explained risk factors like obesity, high blood pressure, high cholesterol, and diabetes all negatively affect your heart health. People who suffer from these factors are at higher risk of developing heart disease, especially when risk factors are poorly controlled or untreated.
Osei-Bagyina said high blood pressure specifically causes your heart to overwork, excessively pumping blood to your heart.
“Then, the heart is going to begin to give up, and that’s how we get into the domain of heart attacks,” Osei-Bagyina said.
In addition to a lack of education about heart disease, O’Conell said genetics has a part in the disproportionate effects of heart disease on Blacks as well.
“Sodium or salt metabolism. For some reason, they may not be able to metabolize salt as well, and that can lead to things like high blood pressure, “O’Connell said. “And that can lead to a cascade of events that over time can increase risk for heart disease.”
Osei-Bagyina said health and lifestyle go hand in hand. He said some studies show that more than 70 percent of salt intake happens before foods gets into your home, pointing out that some foods are manufactured with higher sodium levels than others.
He said it’s important to read food labels to get a better understanding of the food that you’re consuming.
Despite fighting against genetic factors that make it harder for Black Americans to breakdown sodium, causing an increased risk for high blood pressure and high cholesterol which can eventually lead to heart disease, Black Americans who are at risk for heart disease can make adjustments to improve their heart health. These adjustments include changing their eating habits, exercising more, limiting their salt intake, and refraining from smoking.
But, one other risk factor is nearly impossible to manage or treat. O’Connell and Osei-Bagyina both stressed that socioeconomic disparities between Black and white racial groups act as independent risk factors for heart disease.
An independent risk factor is anything that significantly contributes to an outcome. Osei-Bagyina said the way socioeconomic factors drive the increased occurrence of heart disease in Black Americans cannot be ignored.
“You cannot overlook the past, and you cannot overlook the way the system has been set up,” Osei-Bagyina said. “That is again important. Because, for example if you have communities that don’t have access to good healthcare, if you have situations where certain racial groups don’t have access to the same level of healthcare, or the same level education or same level of environment, then definitely the system is set up in a way that some people are naturally going to be predisposed to some of these conditions as well.”
Osei-Bagyina said urban neighborhoods or communities that are inhabited by people who fall lower on the economic ladder tend to lack critical resources that people need to live healthy lifestyles. He said many urban neighborhoods are overwhelmed with fast food restaurants, lacking nearby grocery stores that sell healthy food options.
“These fast foods and foods that don’t promote heart health, they are the foods that are available to people of the lower socioeconomic class,” Osie-Bagyina said. “So, the first thing to do is try to make [healthy food] available. And the fact that you make it available does not mean that people are going to patronize it.”
He said the absence of health care facilities in low-income communities makes it harder for Black Americans and other racial groups who live in those communities to regularly visit doctors and physicians. Other roadblocks like lack of access to reliable transportation also stand in the way of people being able to get the care and resources that they need.
Even disparities seen in the access to quality education circle back to poor heart health, Osei-Bagyina explained. He said not being able to attain a good education directly impacts a person’s ability to secure a good paying job, which ultimately can limit them to living in low-income communities that don’t offer the basic resources that they need.
O’Connell said some a recent study by Tulane University researched how socioeconomic factors impact heart health. He said one socioeconomic factor that the study pointed out that heavily affects heart health is stress. Stress can be onset by financial struggles, lack of support, and other factors that can make a person feel overwhelmed.
“If someone has a problem financially, or some other support, childcare—things like that—it’s hard to really provide support for that,” O’Connell said. “There’s a Northern Light resource we have called findhelp. We use that to try to get people connected to different resources. But it’s not something that we can say, ‘Oh, I’m going to give you this medication and hopefully in two weeks this is going to be better.'”
Osei-Bagyina said research shows that when other racial groups are exposed to the same socioeconomic challenges that many Black Americans experience, they are affected by systemic disparities in the same or similar ways.
O’Connell said new research from a study completed by Tulane University shows that when socioeconomic risk factors like stress, wage gaps, access to adequate healthcare and more are removed, so are the grave differences in the disproportionate effects that heart disease has on Black individuals.
“You can almost get that comparison between Caucasian Americans and Black Americans to a zero percent difference,” O’Connell said.
Osei Bagyina said Black people being increasingly susceptible to heart disease hurts the majority and people of all racial groups.
“These conditions affect individuals, but in the end, they affect everybody,” O’Connell said. “We all have a role to play. If patients or people are not healthy enough, it affects the economy. It affects taxes. It affects so many things. And it goes back to involve everybody.”
Osei-Bagyina said having clear communication with patients and finding ways to better understand how a patient’s home-life and lifestyle may be affecting their heart health is one way physician’s can create individualized health plans that better address the socioeconomic factors that may be impacting their patients.
“Knowledge is important, but knowledge does not translate into action, ” Osei Bagyina said. “And sometimes there is a great disconnect between providers and patients in the first place. Because we tend to tell them what to do instead of reasoning with them as to how to do it. The more we engage them in a conversation, knowing what is right, we may then learn more things about why they’re not doing what they’re supposed to be doing. And that offers another opportunity to even have another further conversation again to nudge them to do what they’re supposed to be doing to promote heart health.”
If you are noticing that you show symptoms of having a heart attack like shortness of breath, chest pain, difficulty breathing or other signs, schedule an appointment with your primary care provider. If you think you’re experiencing signs of a heart attack, call 911 or alert a loved one.
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