NPA Blog: Closing the Gap on Cardiovascular Disease among African Americans

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Closing the Gap on Cardiovascular Disease among African Americans

By Andrew K. Sanderson II, MD, MPH, FASGE, HHS OMH Medical Officer  

Dr Sanderson

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, CVDalso known as heart diseaseis 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. 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.

[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.