How cholesterol causes heart disease in African Americans

The reported rates of heart disease among Black and African American individuals are slightly higher than in white individuals. However, the death rate is between 22 to 25% higher among the former.

This means that Black and African American people have disproportionately higher rates of death from heart disease than their white counterparts.

The following table includes the age-adjusted prevalence of heart disease by percentage of adults in 2019:

The following table includes the age-adjusted death rates per 100,000 population for heart diseases in 2019:

There is a lower percentage of Black and African American adults with high total cholesterol than white individuals. The percentage of the population with high total cholesterol between 2015–2018 is as follows:

Cholesterol is a waxy, fat-like substance that is in all of the body’s cells. The body makes cholesterol to help produce hormones, vitamin D, and substances that help with food digestion.

Healthcare professionals often refer to high-density lipoprotein (HDL) as “good” cholesterol and low-density lipoprotein as “bad” cholesterol.

Higher HDL levels may help lower the risk of heart attack and stroke and have an association with a reduced risk of heart disease.

Conversely, there is an increased risk of cardiovascular disease associated with high LDL levels.

LDL moves cholesterol around the bloodstream to where the body needs it for cell repair, depositing it in the artery walls. Over time, cholesterol deposits can accumulate, narrowing or blocking the arteries that supply blood to the heart and other parts of the body.

Narrowed or blocked arteries prevent blood from reaching the heart, brain, and other organs, possibly resulting in heart attack, stroke, or heart failure.

However, even though African Americans are more likely to have lower LDL levels than other groups, they still have higher rates of death from heart disease. This means factors other than cholesterol may increase their risk of adverse heart disease outcomes.

High cholesterol is not the only factor that may raise a person’s risk for heart disease. Additional risk factors for heart disease may include:

• a family history of heart disease
• high blood pressure
• high cholesterol
• diabetes
• tobacco use
• obesity
• a poor diet
• physical inactivity
• alcohol use

Although these risk factors can affect people of all races and ethnicities, some are more prevalent in African Americans.

For example, high blood pressure is more common. The 2017 American College of Cardiology and American Heart Association guidelines state that approximately 54.9% of non-Hispanic Black people meet the definition for high blood pressure compared with 47.3% of non-Hispanic white individuals.

Diabetes is also more prevalent. The Office of Minority Health states that African American adults were 60% more likely than non-Hispanic white adults to receive a diabetes diagnosis in 2018 and twice as likely to die from it in 2019.

Additionally, 2023 research found that obesity affects 49.6% of African Americans compared with 42.2% of non-Hispanic white people.

African Americans may also have certain socioeconomic factors that may affect their heart disease outcomes, such as lower income, lower education level, unemployment, and certain environmental factors.

Societal determinants of health, including lower income, less education, and environmental factors, have links to structural racism. Centuries of structural racism in the U.S. may have disproportionately exposed African Americans to these factors.

People with lower incomes are less likely than people with higher incomes to:

• receive diagnostic assessments quickly
• have as much access to medicinal interventions
• receive affordable procedures
• complete cardiac rehabilitation
• have access to quality care

People with a lower education level are more likely to:

• have a higher risk of heart disease and death due to conditions of the heart and blood vessels
• have behavioral and biological risk factors, such as obesity, physical inactivity, and high blood pressure
• have a greater number of conditions alongside heart problems but receive fewer interventions
• not adhere to medications due to cost and accessibility

Certain environmental factors can also have associations with a higher risk of heart disease, such as:

• living in a disadvantaged neighborhood
• neighborhood crime
• poor neighborhood safety, which drives physical inactivity
• insufficient availability of healthy food
• easy access to fast-food restaurants

Among African Americans, there can be significant barriers to accessing healthcare, with higher rates of poverty and lower rates of health insurance. The lack of access to healthcare prevents early disease screening and the management of risk factors that improve heart disease outcomes.

People can take the following steps to help lower their risk of heart disease:

• Eat a heart-healthy diet with plenty of fruits and vegetables and fewer processed foods.
• Maintain a moderate weight.
• Aim for at least 30–60 minutes of physical activity each day.
• Do not smoke and stay away from secondhand smoke.
• Get regular health screening tests for blood pressure, cholesterol, and diabetes.
• Limit or avoid alcohol intake.

If someone has a condition, such as high blood pressure or diabetes, a doctor may recommend lifestyle changes and prescribe medicines to manage them.

African Americans have a greater risk of adverse outcomes from heart disease than other racial groups.

Although high cholesterol is a significant risk factor for heart disease, it may not explain the disparity in death rates from heart disease among African American people.

Other risk factors for heart disease, such as high blood pressure or diabetes, may contribute. Socioeconomic factors also play a substantial role in creating barriers that prevent African American communities from accessing high quality healthcare.