Heart disease in African American populations: Prevalence and risk

Higher rates of heart disease in Black Americans shorten their overall life expectancy relative to other groups. Several factors play a role:

Discrimination and racism

Racism continues to be a reality for Black people in the U.S., but historical racism can also affect their lives. For example, segregated neighborhoods mean that Black individuals are less likely to live in unpolluted, walkable neighborhoods with ready access to nutritious food.

Structural racism in the U.S. affects Black people’s access to education and good jobs. It means that they earn, on average, less than white people, are more likely to have negative interactions with police, and have reduced access to quality healthcare.

These issues can affect heart health both directly, such as when a Black person cannot access a cardiologist, and indirectly. Racism is a chronic stressor that can erode health over time.

It is important to note that socioeconomic improvements do not remove the differences in heart health between Black people and those belonging to other populations. Moreover, improvements in education do not remove socioeconomic disparities, pointing to the role of racism. Even with wealth and education, Black people continue to experience higher rates of heart health issues.

Lifestyle factors

Black people in the U.S. have higher rates of lifestyle factors that increase the risk of heart disease. These include:

African American people are less likely than white people to live in walkable, safe neighborhoods, which can contribute to low levels of physical activity and a higher risk of obesity.

Other social factors may also affect these risk factors. For example, a person might overeat or eat “comfort foods” high in fat and added salt or sugar to deal with chronic stress, which can also lead to a higher risk of heart disease.

Social factors

Social and environmental factors also correlate with a higher risk of heart disease. African American people have higher rates of:

• unemployment
• poverty
• difficulty accessing medical care

African American people are also less likely than white people to own a home. Each of these factors can affect cardiovascular health in myriad ways. For example, unemployment is not only stressful, but it can affect financial well-being and possibly the ability to buy nutritious food.

Higher rates of risk factors

Black people in the U.S. have higher rates than white people of heart disease risk factors, including:

In many cases, social factors such as racism influence these risk factors. For example, residential segregation may decrease access to good quality food, while high blood pressure may be the result of chronic stress.

In addition to having a higher likelihood of one risk factor, Black people are also more likely to have multiple risk factors.

Not all people with cardiovascular disease have symptoms. However, those who do may experience:

• fluttering or pounding sensations in the chest
• unexplained fatigue
• swelling, especially in the feet, legs, stomach, or neck veins
• shortness of breath
• irregular heart rate
• exercise intolerance

Some signs of a heart attack, which is an emergency requiring immediate care, include:

• neck or upper back pain
• chest pain
• heartburn, indigestion, nausea, or stomach pain
• shortness of breath
• dizziness
• pain in the upper body
• sweating

These symptoms usually appear suddenly.

A doctor will ask a person about their symptoms and their individual and family medical histories. They will then likely order some tests to confirm the diagnosis. Some common diagnostic tests are:

• blood tests to look for signs of inflammation and markers for heart disease, as well as to check for heart disease risk factors such as diabetes
• an electrocardiogram to measure electrical activity in the heart
• an echocardiogram, which uses ultrasound to check the motion and strength of the heart
• an exercise stress test to see how well the heart works under pressure
• radionuclide perfusion testing or multiple-gated acquisition scanning, which involves injecting radioactive substances into the heart and then using imaging scans to visualize this organ and look for signs of damage
• an MRI scan, which uses magnets to provide an image of the heart
• cardiac catheterization, which involves inserting a long thin tube through a blood vessel to the heart before injecting a dye to help see the heart on an imaging scan

Heart disease is more treatable in the early stages, when numerous treatments can manage the condition and its consequences. Lifestyle changes and cardiac rehabilitation may also help. Cardiac rehabilitation combines education about heart health with support to make lifestyle changes. It can include:

• dietary changes
• exercise
• physical therapy
• medications for heart disease, such as blood pressure or cholesterol medication
• eliminating habits that harm health, such as smoking
• reaching and maintaining a moderate weight

In cases of more advanced disease, surgery may be necessary. This may involve procedures such as:

• the placement of a stent to improve blood flow to the heart
• bypass surgery to bypass blocked blood vessels
• placing a heart valve
• installing a pacemaker
• placing an implantable cardioverter defibrillator to stop harmful irregular heart rhythms

People can take steps to eliminate or reduce the severity of many heart disease risk factors. These steps include:

• managing body weight
• eating a varied, low sodium diet rich in fiber, fruits, vegetables, and lean proteins
• getting at least 150 minutes of moderate intensity exercise, such as brisk walking, or 75 minutes of intense exercise, such as running, per week
• finding a culturally competent doctor who understands and cares about the needs of Black people in their care
• developing strategies for controlling stress, such as meditation or therapy

Not every heart disease risk factor is controllable. Widespread public health solutions are critical because these strategies can reduce the influence of factors such as unsafe neighborhoods and institutional racism.

It is possible to live a long life, even with heart disease, especially if a person follows their doctor’s suggestions and lives a heart-healthy lifestyle. However, heart disease is often fatal, and it can cause sudden death.

Although heart disease death rates are falling among Black people in the U.S., they remain significantly higher than they do for other racial groups. Widespread public health measures, early interventions for individuals at particularly high risk, and safer neighborhoods may help improve this situation over time.

Heart disease is the leading cause of death for people belonging to most racial groups, including African American people. However, African American people tend to develop heart disease risk factors and heart disease in earlier life and may die of heart disease while still relatively young.

It is important that Black people, including young people, understand their heightened risk so that they can be proactive in seeking care and adopting preventive lifestyle measures.

However, individual behavior changes are unlikely to change the statistics significantly because racism, discrimination, segregation, lack of access to quality care, and unsafe environments all play a major role. Therefore, a public health solution is necessary.