The Poorest African Americans at Highest Risk for Heart Disease

By S.C. Rhyne

One in every four deaths in the United States is caused by heart disease, which is the leading cause of death for both men and women, according to the U.S. Centers for Disease Control and Prevention (CDC). 

African Americans at lower socioeconomic levels, particularly women and younger adults, are at greater risk of heart disease and stroke than those in higher socioeconomic positions according to a new study.

Nearly half of all African American adults have some form of cardiovascular disease (CVD), and they are twice as likely as white adults to have a first-ever stroke, according to research was published in the Journal of the American Heart Association on May 27.

Scientists analyzed data from more than 5,300 Black Americans from the Jackson Heart Study, in the Jackson, Mississippi area; participants were followed for up to 10 years.

During this time, 362 new or recurrent CVD events were recorded, including heart attacks, heart disease deaths, strokes and cardiovascular procedures. Of these events, 213 were in women and 149 were in men.

Multiple measures were used to assess participants, including education, income, wealth and public assistance. For each measure, they divided the study population into thirds by defining low, medium and high.

Researchers also adjusted for known behavioral and health risk factors such as smoking, alcohol use, physical activity, body mass index, type 2 diabetes, hypertension and cholesterol.

Participants’ socioeconomic status was assessed in both adulthood and childhood, though family income during childhood wasn’t linked to later-life cardiovascular risks.

“African Americans with low socioeconomic status (SES) are more likely to have higher rates of obesity, hypertension, type 2 diabetes and physical inactivity compared to their counterparts of higher SES,” said lead study author, Samson Y. Gebreab, Ph.D., M.Sc. to Reuters Health. “  

Another possible explanation is that African-American women of low SES experience higher rates of psychosocial stressors such as chronic stress, depression, discrimination and are more likely to live and work in a worse physical and social environment.”

This means that poorer Black women have far fewer resources at their disposal to cope with these stressors and thus creates a recipe for a higher risk of heart attack and stroke. 

Resources could mean access to healthcare, healthy food options or safe streets/place to exercise—including parks or playgrounds.

Here is a rundown of the major findings:

*Women in the lowest socioeconomic group had more than twice the risk of experiencing a CVD event than those in the highest group.

*Men and women 50 years and younger in the lowest socioeconomic group had more than three times the risk of experiencing a CVD event than those in the highest group. 

*Being an African American adult age 50 or younger or an African American woman of any age remained independent predictors of CVD.

By itself, wealth proved to be an independent predictor of CVD in women. Those in the lowest third were 68 percent and those in the middle third were 61 percent more likely to experience a CVD event than those in the top third.

Cardiologist Dr. Ola Akinboboye Heart Smart Messages Should be Delivered in Black Churches

by Clem Richardson

Dr. Ola Akinboboye and his Association of Black Cardiologists wanted a video that would link African-American lifestyles to the heart disease epidemic ravaging the community. They found it.

“Before You Eat The Church Food Watch This Video,” is the film, and Akinboboye, 52, the Rosedale, Queens-based president of the 2,500-member international ABC, hopes it will help decrease the alarming health issues afflicting the African-American communities many of his members serve.

“The average black man lives 68 years, while the average white woman lives to 85,” Akinboboye said. “African-Americans have heart attacks, high blood pressure, diabetes, kidney failure and dialysis at rates that are 20 to 30 percent higher than whites. That is the frustration for cardiologists, trying to eliminate these disparities.”

While some of those differences may have genetic origins, most are lifestyle issues, many traceable to the way African-Americans historically use and prepare food, he said.

Akinboboye believes another traditional African-American stalwart, the black church, can be used to create more heart-friendly menus in African-American households. Change the church menu, you change the home one as well.

“If you look at the eating habits of our forefathers during slavery times, you see their food reflects a creative and adaptive response to racial oppression and poverty,” Akinboboye said. “If you look at it objectively, it is actually slave food. Slaves did not have access to choice cuts of meat. They had to make do with the less desirable parts, like intestines, or chitlins, and hamhocks.”

Much of that food is high on the glycemic index, meaning once eaten they can raise blood sugar levels fairly quickly. Muscles convert this sugar to energy. Any excess is stored in the fatty tissue.

But slaves worked hard on backbreaking jobs, burning off most of the sugar in their bloodstream. “The high sugars are what they needed at the time to deal with what they needed to deal with,” Akinboboye said. “They were cultivating large portions of land, and needed large portions of food and the energy it provided to do that work.”

It is one of the blessings of progress that modern African-Americans generally don’t work as hard as their ancestors. But with eating habits learned from their ancestors, many African-Americans still regularly chow down on high calorie “soul food” without getting anything close to the exercise their forebearers did.

“We have been dealt a different set of cards but are playing the same game,” Akinboboye said. So they gain weight, sometimes lots of it, and suffer from the ailments obesity brings, including high blood pressure, heart disease, diabetes, kidney failure, etc.

Akinboboye, who is also executive director of the Queens Heart Institute, in Rosedale, and an associate professor at Cornell Weill Medical Center, said the shame of it is that most of these ailments are preventable.

“The biggest advance in heart health in the past decades is not angioplasty or bypass surgery, it is understanding that heart disease can be prevented by paying attention to blood pressure, by getting people to exercise and watch what they eat,” he said. “Those things go a long way beyond what we can do with angioplasty.”

The “Before You Eat the Church Food” video is that brainchild of Washington, DC television news anchor Bruce Johnson, who, since suffering a heart attack at 40 years old has devoted much of his career to educating African-Americans about heart health.

Akinboboye said the ABC, with offices in Washington, D.C. and in Times Square, focused on the church because “even though people only go one day a week, it determines how they live their lives the other six days.

“In these church dinners you see a lot of cornbread, rice, fried chicken — the holy bird,” he said. “People go to church events and see these foods displayed and assume they can eat them the same way at home.”

The video shows the ill effects of eating too much, but also suggests different ways to prepare traditional soul food that decreases the fat content. “We’re not saying not to eat it, just eat smaller portions, or less rice and cornbread and hamhocks and more greens,” Akinboboye said.

“This is not an attack on the black church,” he said. “The ABC has always been rooted in the community. We have had programs involving black barber shops and beauty salons. This is a natural extension of that outreach.”

Broken Heart Syndrome and Older Black Women

by Kenny Anderson

“Long before the term Broken Heart Syndrome was coined my mother suffered from it! She watched her three year old son hit by a car and killed and many years later she found her oldest son in the bed dead. My mother was grief stricken most of her life; she suffered silently and often had crying spells. I believe the impact of the Broken Heart Syndrome along with the daily stress of racism over the years was the major cause of my Black mother’s death” – Kenny Anderson, Founder of Black Hearts Matter

Broken Heart Syndrome also known as stress-induced 'cardiomyopathy’ or ‘takotsubo cardiomyopathy’, is a condition triggered by an onset of emotional distress. The symptoms of broken heart syndrome are very similar to those of a heart attack, and they can include angina (chest pain), shortness of breath, low blood pressure, and temporary heart failure.

The John Hopkins Heart and Vascular Institute describes stress-induced cardiomyopathy as a condition in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy). This condition can occur following a variety of emotional stressors such as grief (e.g., death of a loved one), fear, extreme anger, and surprise. 

Broken Heart Syndrome can also occur following numerous physical stressors to the body such as stroke, seizure, difficulty breathing (such as a flare of asthma or emphysema), or significant bleeding; it is more prevalent in postmenopausal women; these women often have a history of emotional or physical stress. 

The first generation of my enslaved maternal African ancestors suffered from being 'homesick' stolen from Africa and 'heartbroken' from their children being sold away from them, thus they were the first to suffer from Broken Heart Syndrome. The historic higher incidences of Broken Heart syndrome among Black women has made them more vulnerable to heart disease and a contributing factor of Black women having the highest heart disease rates in America.

Older Black women have experienced a lot of deaths over the years particular the premature deaths of the Black men in their lives (fathers, brothers, sons, husbands, friends, etc.). Generally older Black women have never had grief counseling and suffer emotionally from prolonged unresolved ‘compounded grief’. Indeed, older Black women are at a much greater risk of Broken Heart Syndrome due to a greater accumulation of emotional distress over the years.

The most harmful aspect of heartbreak is that it is incredibly stressful, and when we are stressed, our bodies produce an excess of the hormones adrenaline and cortisol. In small doses these hormones raise the heart rate, which is not such a bad thing, but high levels can overwhelm the heart and in some cases actually result in heart failure.

Studies show that emotional distress does indeed affect the physical body in a number of different ways. First of all, emotional pain causes blood to flow to regions of the brain that are also responsible for producing physical pain. This is why many people may feel what psychologists call ‘somatosensory representations’ of pain after a hurtful experience such as rejection. Secondly, heartbreak can interfere with your immune system, which in turn can cause inflammation and a weakening of defenses against illness and infection.

Frequently Asked Questions:

1. What is “Broken Heart Syndrome?” 
Broken Heart Syndrome, also referred to as 'stress cardiomyopathy', is a condition in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy). This condition can occur following a variety of emotional stressors such as grief (e.g. death of a loved one), fear, extreme anger, and surprise. It can also occur following numerous physical stressors to the body such as stroke, seizure, difficulty breathing (such as a flare of asthma or emphysema), or significant bleeding.

2. What are the symptoms of stress cardiomyopathy?
Patients with stress cardiomyopathy can have similar symptoms to patients with a heart attack including chest pain, shortness of breath, congestive heart failure, and low blood pressure. Typically these symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected, stress.

3. Is stress cardiomyopathy dangerous?
Stress cardiomyopathy can definitely be life threatening in some cases. Because the syndrome involves severe heart muscle weakness, patients can have congestive heart failure, low blood pressure, shock, and potentially life-threatening heart rhythm abnormalities. The good news is that this condition improves very quickly, so if patients are under the care of physicians familiar with this syndrome, even the most critically ill tend to make a quick and complete recovery.

4. How does sudden stress lead to heart muscle weakness?
First, it is important to understand what “stress” is. “Stress” refers to the body’s response to things it perceives as abnormal. These abnormalities can be physical such as high body temperature, dehydration, or low blood sugar, or can be emotional, such as receiving news that a loved one has passed away. When these abnormalities occur, the body produces various hormones and proteins such as adrenaline and noradrenaline which are meant to help cope with the stress. For example, if a person is suddenly threatened and fears physical harm, the body produces large amounts of adrenaline to help that person either defend himself/herself or run faster to escape the danger. With stress cardiomyopathy, we believe that the heart muscle is overwhelmed by a massive amount of adrenaline that is suddenly produced in response to stress. The precise way in which adrenaline affects the heart is unknown. It may cause narrowing of the arteries that supply the heart with blood, causing a temporary decrease in blood flow to the heart. Alternatively, the adrenaline may bind to the heart cells directly causing large amounts of calcium to enter the cells which renders them temporarily dysfunctional. Whichever the mechanism, it appears that the effects of adrenaline on the heart in this syndrome are temporary and completely reversible. As will be discussed further in question 5, one of the main features of this syndrome is that the heart is only weakened for a brief period of time and there tends to be no permanent or long-term damage.

​5. How does stress cardiomyopathy differ from a heart attack?
Stress cardiomyopathy can easily be mistaken for heart attack. Patients with this syndrome can have many of the same symptoms that heart attack patients have including chest pain, shortness of breath, congestive heart failure, and low blood pressure. With a closer look, however, there are some major differences between the two conditions. First, most heart attacks occur due to blockages and blood clots forming in the coronary arteries, the arteries that supply the heart with blood. If these clots cut off the blood supply to the heart for a long enough period of time, heart muscle cells can die, leaving the heart with permanent and irreversible damage. This is completely different from what is seen with stress cardiomyopathy. First, most of the patients with stress cardiomyopathy that both we and others have seen appear to have fairly normal coronary arteries and do not have severe blockages or clots. Secondly, the heart cells of patients with stress cardiomyopathy are “stunned” by the adrenaline and other stress hormones but not killed as they are in heart attack. Fortunately, this stunning gets better very quickly, often within just a few days. So even though a person with stress cardiomyopathy can have severe heart muscle weakness at the time of admission to the hospital, the heart completely recovers within a couple of weeks in most cases and there is no permanent damage.

6. I am under a great deal of stress every day. Is it possible that I have been walking around with stress cardiomyopathy and did not even know it?
While there is no debate that chronic stress can have effects on human health, stress cardiomyopathy appears to be a condition that comes on suddenly and unexpectedly and resolves quite quickly. If you are a person who frequently has symptoms of chest pain or shortness of breath when under significant stress, you should be evaluated by your doctor. He or she may want to perform some basic tests to make sure you are in god health. It is unlikely, however, if your symptoms have been going on for a while that you have stress cardiomyopathy.

​7. Who is at risk for getting stress cardiomyopathy? 
Because stress cardiomyopathy is a relatively newly appreciated syndrome, we are only beginning to understand why it happens and who is most likely to get it. Most of the patients we have seen with it do not have a previous history of heart disease. It is quite clear from the available medical literature so far, however, that stress cardiomyopathy affects primarily women. In addition, it tends to occur most frequently in middle aged or elderly women (average age about 60). While it can also occur in young women and even in men, the vast majority of the patients we have seen with this are post-menopausal women. The exact reason for this is unknown, and further research will be necessary to help explain this observation.

8. Once a person has had stress cardiomyopathy, will they get it again the next time they are under severe stress?
From what we have seen so far, the answer to this question appears to be no. While it is possible that the syndrome could recur, this is not what we have observed at our hospital. In the five years that we have been following patients with stress cardiomyopathy, none have experienced the syndrome a second time. Further, several of our patients went on to have other stressful events in their lives and none developed the syndrome again.

9. If I have had stress cardiomyopathy, what is my long-term prognosis? 
Because the heart muscle is not permanently damaged with this syndrome, patients typically make a rapid and complete recovery. From our experience and from what has been published by other groups, the long-term prognosis for patients with stress cardiomyopathy appears to be excellent.

Heart Disease Crisis in Black America

by Kenny Anderson

Heart disease disproportionately affects Blacks in America, a 2009 study published in the New England Journal of Medicine revealed that one in 100 Black men and women between 18 and 30 develops heart failure before age 50, a rate that is 20 times higher than whites in the same age group. 

According to 2013 data from the American Heart Association 48% of Black males age 20 and older have heart disease, while 44% of Black males age 20 and older have heart disease. 

Heart disease is the number one killer of Black women and men in America. Black women’s death rate from heart disease is 31% and Black men’s death rate from heart disease is 34%. Black men are 30% more likely to die from heart disease than white men; Black men account for over 100,000 more heart disease deaths than white men.

Black men and women are more likely to die of a heart attack or heart failure than whites in the United States. A study (2003 – 2007) at the University of Alabama at Birmingham shows that every year during the study, 4 in 1,000 Black men died from heart disease, on average compared to 1.9 of 1,000 white men, the researchers found. Among women, 2 in 1,000 Blacks died of heart disease each year, compared to 1 in 1,000 whites.

Though Blacks suffer from much higher rates of heart disease they receive less heart catheterizations. A study that appeared in the March issue of Journal of the National Medical Association, researchers compared the rates of cardiac catheterization in about 585,000 white, 51,000 black, and 32,000 Hispanic people treated for heart attack in U.S. hospitals from 1995-2001. Researchers found cardiac catheterization rates were higher for whites than Blacks for all years examined, while rates among Hispanics approached that of whites during the study period.

  

Slavery Connection and Black Heart Disease

One enduring critical issue that has negatively impacted Blacks from past to present is the stress of racism. The American Journal of Human Biology contains details of two studies that contend that poor nutrition and stress stemming back to the days of slavery could help explain Black-white differences in cardiovascular health in the United States.

In one study, researchers from Northwestern University explain how nutrients and hormones present in the womb can profoundly shape a fetus's development, in part by silencing certain genes. These influences, say the research team, can persist into later life to impact adult health, a process known as 'fetal programming'. The researchers argue that such inter-generational impacts of environmental factors could help explain racial health differences.

Christopher Kuzawa and Elizabeth Sweet who co-authored the research article says a pregnant African American mother's experience of well documented stressors including social forces such as discrimination and racism could have lingering effects on diseases like hypertension, diabetes, and heart attacks in her children.

By synthesizing this new evidence, they argue that the socioeconomic stress forces, rather than genes, may underlie the problem of racial inequity in heart attacks and strokes. Indeed the social force strain of racist socioeconomic deprivation and stress wreaks havoc on the minds and bodies of Black men that causes greater emotional distress and heart disease. Tupac Shakur once rapped that every day too many Black men “got to try to make a dollar out of 15 cents.”

Stress and High Rates of Black Heart Disease

One enduring critical issue that has negatively impacted Blacks from past to present is the emotional distress of racism. In her book, ‘Environmental Stress and African-Americans’, author Grace Carroll states that race is brought to the consciousness of African Americans every day through interaction with employers, service providers, landlords, the police, and the media. 

Carroll says the stress experienced by Blacks merely as a result of being African American causes micro-aggressions that include experiences such as being denied jobs, being targeted, being falsely accused, being negatively portrayed and singled out on account of one's race.

Carroll labels the stress resulting from such micro-aggressions as Mundane Extreme Environmental Stress (MEES) that has a daily significant negative impact on one's psychological well-being, physical health, and world view; it is environmentally induced, frustrating, detracting, energy consuming, immune draining, and overwhelming. 

Racism induced emotional distress whether in the form of stress, worry, depression, or anger can increase the risk of heart disease, heart attack, and stroke a growing body of research studies have found.

A research team led by Carnegie Mellon University's Sheldon Cohen has found that chronic psychological stress is associated with the body losing its ability to regulate the inflammatory response. Published in the Proceedings of the National Academy of Sciences, the research shows for the first time that the effects of psychological stress on the body's ability to regulate inflammation can promote the development and progression of disease.

Cohen argued that prolonged stress alters the effectiveness of cortisol to regulate the inflammatory response because it decreases tissue sensitivity to the hormone. Specifically, immune cells become insensitive to cortisol's regulatory effect. In turn, runaway inflammation is thought to promote the development and progression of many diseases.

Another study provides a better understanding of why chronic stress leads to high levels of inflammation in the body. Researchers found that chronic stress changes gene activity of immune cells before they enter the bloodstream so that they're ready to fight infection or trauma even when there is no infection or trauma to fight. This then leads to increased inflammation.

The University of California, Los Angeles researchers looked at blood samples from both the stressed mice, as well as humans who came from differing socioeconomic statuses. Just like in the mouse part of the experiment, 387 genes were identified that had differences in activity between the people who came from low socioeconomic backgrounds and those who came from high socioeconomic backgrounds. 

And just like in the mice, the up-regulated genes in those who came from low socioeconomic backgrounds were pro-inflammatory.