By Andrew K. Sanderson II, MD, MPH, FASGE, HHS OMH
Medical Officer
Cardiovascular
disease (CVD) is a leading killer in the United States, and African Americans are
excessively burdened by poor cardiovascular health.[i]
[ii]
[iii]
Adding to this burden are barriers to high-quality and timely health care. As a
result, CVD is often diagnosed too late, leading to a disproportionate number
of African Americans suffering and dying from heart disease every year, compared
to non-Hispanic whites. In addition, African Americans often live in
communities where they lack access to affordable, healthy foods or safe places
to be physically active. These challenges contribute to diabetes, high cholesterol, and obesity—all of which are risk
factors for CVD.
We can reduce deaths and hospitalizations for CVD by better
understanding the causes of heart disease, making necessary lifestyle changes,
getting preventive heart screenings, and knowing what treatment resources are
available.
Causes of Heart
Disease
One of every three
deaths in the U.S. is due to CVD.[iv] However, CVD—also known as heart
disease—is preventable. The clinical guidelines for the prevention and
management of heart disease include adopting healthy behaviors (e.g., not
smoking, following a healthy diet, and being physically active) and early
detection and management of clinical risk factors (e.g., elevated blood pressure,
obesity, and diabetes).[v]
Uncontrolled blood pressure is a clinical risk factor for
CVD. If high blood pressure goes
untreated, it can significantly increase the risk of heart disease. Key factors
in controlling blood pressure are maintaining a well-balanced diet and increasing
physical activity—healthy behaviors can help alleviate the chronic stress and elevated
blood pressure already experienced by many African Americans.[vi]
Genetics also play an important role in cardiovascular
health. If any of your close relatives
has had heart disease, then it’s all the more important to take the necessary
steps to reduce the risk of CVD.
Beyond clinical
factors, health behaviors, and genetics, there is growing recognition that
“social determinants”—the conditions in which people live, learn, work, and
play—also impact CVD.[vii],[viii]
For example, some African Americans live in neighborhoods where many
options for foods have high amounts of sodium (salt).
Finally, lack of trust in health care providers contributes
to poor cardiovascular health. Mistrust leads patients to avoid using
prescribed medications or treatments, which, in turn, leads to poor cardiovascular
health outcomes.
What can be done?
On an individual
level- Drinking in moderation, replacing unhealthy fatty foods with more
vegetables, getting regular exercise, and obtaining preventive health
screenings are key elements for reducing the risk of heart disease.
Other lifestyle changes can contribute greatly to heart
health. For example, if you smoke, quit now. Smoking causes significant damage
to the cardiovascular system and poses a variety of risks to smokers’ health
and well-being. Smokefree.gov has many
resources to help people who want to quit smoking.
On a system level-
Food manufacturers can reduce the sodium content of foods across the board. Restaurants
can display sodium and calorie contents on menus nationwide. Health systems can
use electronic health records (EHRs) to keep track of patients not being
treated for hypertension or not meeting blood pressure goals.
Another crucial step to reducing cardiac events is
controlling other chronic diseases—such as diabetes and obesity—that are major contributors
to heart disease and prevalent in the African American community. Increasing
access to care and enrollment in disease management programs has been proven to
save lives.
The Million
Hearts campaign, developed by the U.S. Department of Health and Human
Services, provides information on risk factors, preventive measures, tools, and
the latest data surrounding hypertension and heart disease.
Using the available resources and making a conscious effort
to live a healthier lifestyle will go a long way toward reducing CVD among
African Americans.
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[i] Writing Group Members et al., “Heart Disease
and Stroke Statistics-2016 Update: A Report From the American Heart
Association,” Circulation 133, no. 4 (January 26, 2016): e38–360,
doi:10.1161/CIR.0000000000000350.
[ii] George A. Mensah et al., “State of Disparities
in Cardiovascular Health in the United States,” Circulation 111, no. 10
(March 15, 2005): 1233–41, doi:10.1161/01.CIR.0000158136.76824.04.
[iii]
Kirsten Bibbins-Domingo et al., “Racial Differences in Incident Heart Failure
Among Young Adults,” N Engl J Med 360 (March 2009): 1179-1190. DOI: 10.1056/NEJMoa0807265
[iv] Writing Group Members et al., “Heart Disease
and Stroke Statistics-2016 Update: A Report From the American Heart
Association,” Circulation 133, no. 4 (January 26, 2016): e38–360,
doi:10.1161/CIR.0000000000000350.
[v] Thomas A. Pearson et al., “AHA Guidelines
for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update,” Circulation
106, no. 3 (July 16, 2002): 388–91, doi:10.1161/01.CIR.0000020190.45892.75.
[vi] Tanya
M. Spruill. “Chronic Psychosocial Stress and Hypertension”. Curr Hypertens Rep.
2010 Feb; 12(1): 10-16. doi: 10.1007/s11906-009-0084-8
[vii] Michael Marmot et al., “Closing the Gap in a
Generation: Health Equity through Action on the Social Determinants of Health,”
The Lancet 372, no. 9650 (November 14, 2008): 1661–69,
doi:10.1016/S0140-6736(08)61690-6.
[viii] Edward P. Havranek et al., “Social
Determinants of Risk and Outcomes for Cardiovascular Disease,” Circulation
132, no. 9 (September 1, 2015): 873–98, doi:10.1161/CIR.0000000000000228.
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