Cardiobrief.org
10/23/2017
Cardiovascular disease led to the loss of more than 2 millions years of life in the African-American population between 1999 and 2010.
A new scientific statement from the American Heart Association, Cardiovascular Health In African American makes it clear that, compared to whites, African Americans suffer disproportionately from cardiovascular disease and have not benefited equally from the long-term population-wide reductions in heart disease and stroke.
Large disparities in overall health in general and cardiovascular disease in particular have long been known to exist in African Americans. The new report finds little improvement in the past decade.
In 2012, life expectancy of African American was 75.5 years compared with 78.9 years for whites — a discrepancy of 3.4 years. According to the CDC, cardiovascular disease accounts for 32% of the difference in men and 43% of the difference in women. Cardiovascular disease also starts earlier in African Americans.
Hypertension and Other Risk Factors
Hypertension, according to the statement, “is arguably the most potent risk to the cardiovascular health of African Americans, as well as the greatest area of opportunity for the prevention of disease if effectively managed and prevented.”
Among African Americans, 42.4% of men and 44% of women have hypertension. The hypertension epidemic begins early in African Americans. 13.8% of African-American children have hypertension, compared with 8.4% in whites.
Garth Graham, a cardiologist who was formerly the Deputy Assistant Secretary for Minority Health at HHS and now is president of the Aetna Foundation, commented:
Date: July 10, 2017
Source: American Heart Association
Black men may have similar risk of coronary heart disease as white men, but their first cardiac event is twice as likely to be fatal.
Hypertension likely contributes to the greater toll caused by stroke in African Americans. Stroke mortality rates are 4.5 times higher in nonwhites than in whites.
Obesity is also more prevalent among African Americans. 20% of African-American children are obese, compared with 15% of whites. Among African-American adults, 58% of women and 38% of women are obese; among white adults, 34% of men and 33% of women are obese.
By contrast, African Americans have similar lipid levels as whites. They also have a lower prevalence of atrial fibrillation. But this is offset by the finding that, if they have atrial fibrillation, they are less likely to receive treatment with warfarin.
The scientific statement notes that “fewer socioeconomic resources” leads to “adverse social and environmental factors” contributing to the health disparities.
Obesity is also more prevalent among African Americans. 20% of African-American children are obese, compared with 15% of whites. Among African-American adults, 58% of women and 38% of women are obese; among white adults, 34% of men and 33% of women are obese.
By contrast, African Americans have similar lipid levels as whites. They also have a lower prevalence of atrial fibrillation. But this is offset by the finding that, if they have atrial fibrillation, they are less likely to receive treatment with warfarin.
The scientific statement notes that “fewer socioeconomic resources” leads to “adverse social and environmental factors” contributing to the health disparities.
Stress may also be an important factor: “Although most people experience stress from jobs and major life events, African Americans are more likely to have persistent economic stress and to face concerns about maintaining their health, including preventing weight gain and managing chronic conditions such as high blood pressure or diabetes,” explained Mercedes Carnethon (Northwestern), chair of the statement writing group.
Solutions
To address the problems raised in the statement the authors suggested leveraging some of the “strengths of the cultural environment to disseminate behavioral health interventions (eg., the central role of the church for reaching women and older adults).”
Solutions
To address the problems raised in the statement the authors suggested leveraging some of the “strengths of the cultural environment to disseminate behavioral health interventions (eg., the central role of the church for reaching women and older adults).”
They recommend “targeting the macro-environment via policy changes at the federal (eg., Affordable Care Act), state (eg., cigarette smoking bans), and local (eg., food availability in schools) levels.”
But, they acknowledged, “finding strategies that reach younger African Americans and men with disease prevention messages is a challenge that must be met to change the trajectory of health in the African-American community.”
Garth Graham, a cardiologist who was formerly the Deputy Assistant Secretary for Minority Health at HHS and now is president of the Aetna Foundation, commented:
“The statement accurately reflects what other science and evidence has pointed to over the years as it relates to heart disease and the African-American population, including what was published in the most recent National Healthcare Disparities Report.”
The statement, he continued, “does highlight challenging data on the impact of hypertension and obesity on African-American children, which urges us to be more proactive in finding solutions.
The statement, he continued, “does highlight challenging data on the impact of hypertension and obesity on African-American children, which urges us to be more proactive in finding solutions.
The multifaceted nature of the problem, including socioeconomic status, stress and culture, requires a similar multi-pronged approach that targets the environment but also raises the importance of education and economic security and its impact on heart disease.
The next step for us as a country is moving from describing the problem to focusing on how we make the necessary changes to improve these health outcomes.”
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Blacks Suffer Higher Rates of Fatal First-Time Heart Attacks Than Whites
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Blacks Suffer Higher Rates of Fatal First-Time Heart Attacks Than Whites
Date: July 10, 2017
Source: American Heart Association
Black men may have similar risk of coronary heart disease as white men, but their first cardiac event is twice as likely to be fatal.
That means preventing a first heart attack is even more crucial for blacks, according to research findings reported in the American Heart Association's journal Circulation.
In an analysis that examined cardiac events in three major heart studies, researchers found that in two of these studies, black adults aged 45-64 have about twice the risk of fatal events compared with whites.
In an analysis that examined cardiac events in three major heart studies, researchers found that in two of these studies, black adults aged 45-64 have about twice the risk of fatal events compared with whites.
The same is true for older individuals, with less pronounced differences. The study found that this high risk may be due to cardiovascular risk factors and the conditions in which people are born, grow, work and live known as 'social determinants of health'.
However, the findings differed for nonfatal events. Accounting for these same factors resulted in lower risk of nonfatal events in black men compared to white men, with similar patterns among women that were not statistically significant.
However, the findings differed for nonfatal events. Accounting for these same factors resulted in lower risk of nonfatal events in black men compared to white men, with similar patterns among women that were not statistically significant.
According to the researchers, blacks have a higher burden of unfavorable social determinants of health and cardiovascular risk factors, so the lower risk of nonfatal cardiac events among blacks, especially black men, after accounting for these factors was surprising.
These findings suggest that some other factor that the researchers could not measure may be driving the findings.
"Our concern is that blacks may not be seeking medical attention for important symptoms that could signal heart problems," said Monika Safford, M.D., senior author and John J. Kuiper Professor of Medicine and Chief of General Internal Medicine at Weill Cornell Medical College in New York.
"Our concern is that blacks may not be seeking medical attention for important symptoms that could signal heart problems," said Monika Safford, M.D., senior author and John J. Kuiper Professor of Medicine and Chief of General Internal Medicine at Weill Cornell Medical College in New York.
"Greater public awareness of heart attack symptoms would benefit everyone. Many people think that heart attacks are only present if they have severe chest pain.
In fact, many heart attacks cause only mild symptoms and people may mistakenly think they are having a bout of indigestion." If the heart condition is not recognized, medications that save lives after a heart attack cannot be offered.