Heart disease still a risk for older and younger Black Americans

Camilla Edwards developed postpartum cardiomyopathy several months after having her first child.

The condition is a rare form of heart failure that happens during the last month of pregnancy or up to five months after giving birth. The disease causes the heart to enlarge and to weaken, leading to not enough oxygen flowing to key organs.

“Once I was diagnosed, I could no longer work,” said Edwards, 47, a former school bus driver and mother of two who lives in Palmetto Bay. She gave birth in 2005.

Edwards credits her doctor with helping her to live with heart disease.

“Having an African American doctor like St. John has really helped me to learn about my condition and diagnosis. St. John is a gentle giant and he helped me through the process,’’ said Edwards, who, as an African American, has a higher risk of heart disease than whites. Marcus St. John, a cardiologist with Baptist Health’s Miami Cardiac & Vascular Institute, is her physician.

The higher risk of heart disease in the Black community often starts with hypertension, or high blood pressure. Black men and women between the ages of 35 and 64 are 50 percent more likely to have high blood pressure than whites, according to the Centers for Disease Control and Prevention.

And younger Blacks are living with high blood pressure at greater rates than younger whites, the CDC has found. In 2015, 12 percent of Blacks between the ages of 18 and 34 had high blood pressure, compared with 10 percent of whites. The disparity grew in the 35-49 age bracket, with 33 percent of Blacks having high blood pressure, compared with 22 percent of whites. It grew further in the 50-64 age group, with 61 percent of Blacks having high blood pressure, compared with 41 percent of whites.

But there’s good news: The leading causes of death for African Americans 65 and older — heart disease, cancer and stroke — decreased from 1999 to 2015, and the biggest difference was related to heart disease. During this period, heart disease as a cause of death for African Americans in this age group dropped 43 percent, compared with a 38 percent decline for whites.

Heart disease is the leading cause of death in the United States for all people. High blood pressure, obesity and diabetes are the most common risk factors of heart disease and stroke, according to the American Heart Association.

Edwards has all of these conditions.

Other risk factors include sleep apnea, smoking, alcohol, a family history of early heart disease, sedentary lifestyle, high cholesterol, and certain types of rheumatological diseases.

How to cut your risk of heart disease

Practicing a healthy lifestyle and cardiovascular screenings can greatly help combat heart disease, said Jeffrey Goldberger, chief of the cardiovascular division at the University of Miami Miller School of Medicine.

He notes the American Heart Association Life’s Simple 7 list, which cites seven risk factors of heart disease that can be improved through lifestyle changes: managing blood pressure, controlling cholesterol, reducing blood sugar, getting active, eating better, losing weight and stopping smoking.

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“I tell patients 90 percent of heart health is dependent on them and not on the doctor,” Goldberger said. “It’s really all these things that you can do for yourself that really make the most difference.”

Goldberger noted they are conducting a study to explore the source of the difference and the prevalence of atrial fibrillation in the Black community compared to the white population. Atrial fibrillation is an irregular and often very rapid heart rhythm or arrhythmia that can lead to blood clots in the heart. It also increases the risk of stroke, heart failure and other heart-related complications.

“The biggest risk factor for atrial fibrillation is hypertension, which is more prevalent in the African American community,” Goldberger said. “It seems like that is almost a dissonance that hypertension is more prevalent and atrial fibrillation is less (within the Black community). Our hypothesis is that the fat tissue around the heart, which is associated with atrial fibrillation, may be playing a significant role here because African Americans have less of this fat tissue around the heart than whites.”

Socioeconomic factors at play

While there is a higher prevalence of risk factors for heart disease in the African American community, socioeconomic factors also play a key role, said St. John, the cardiologist who treats Edwards.

“If people are living in neighborhoods where it is not safe to walk, that becomes a challenge,” said St. John. “Some people living on low or fixed incomes very often don’t have easy access in their neighborhood to healthy nutritious foods or can’t afford it.”

There is often a sense of distrust in the Black community of the health care system because of historical areas of abuse, lack of care or lack of cultural competency among providers, St. John said.

“None of those things are insurmountable,” said St. John. “But I think it requires an understanding of that to take the necessary steps at a policy and community level to make people feel welcome who may not feel welcome.”

Setting up community health centers

Lack of health insurance can also hinder people from seeking the treatment they need. The Affordable Care Act has helped more people acquire health insurance, said St. John. Establishing community health centers in underserved locations can also help provide care.

“Not having access to a primary care physician close to where you live and having to take two buses to receive care can disincentivize people to seek access and stay engaged in health care,” St. John said.

Due to being diagnosed with postpartum cardiomyopathy after the delivery of her first child, Edwards said she was told not to have any more children. She has been hypertensive since childhood, and is prediabetic and overweight. But unbeknownst to her, she became pregnant a second time.

“By the grace of God, I’m still here,” said Edwards, whose son and daughter are now 15 and 16, respectively. “I’m a true believer of God. I trust and believe in God. I would tell others to don’t live in fear of the condition and to live your life.”

And, she notes, following your doctor’s advice is key, along with taking your medication.