Distinction Between Heart Attacks and Sudden Cardiac Arrest

by Kenny Anderson

Recently I had a discussion with a friend who highlighted a question to me of “why so many Blacks in their early 50’s and younger were dying from heart attacks particularly Black males.”

This question was posed to me because my friend knew that as a Community Health Representative I had started ‘Black Hearts Matter’ as an effort to both increase heart health literacy and to decrease the super-disproportionate rates of Black heart disease.

 
My initial response was that it was not surprising that a lot of Blacks in their early 50’s and younger were dying from heart attacks due to 60% of adult Blacks having heart disease based on recent data from the American Heart Association.

According to a study by the American Heart Association’s Scientific Sessions (2021) found that Black young adults average age of 31 years between 2007 and 2017 in the U.S. experienced increased cardio-vascular disease risk factors and worsened hospital outcomes.

In an issue of the New England Journal of Medicine (2019), researchers reported that in a study heart failure developed at an average age of 39 among the Black participants.

 
By the tenth year of the study, when participants were between 28 and 40 years old, almost 90% of participants who later developed heart failure had untreated or poorly controlled high blood pressure.

After leaving my discussion with this friend and going home, I felt it was important to further elaborate on this question in writing on Blacks in their early 50’s and younger dying from heart attacks. 

What most Blacks don’t understand is what they think is Blacks dying from heart attacks is too often Blacks dying from Sudden Cardiac Death (SCD) due to cardiac arrest; there is a distinction between the two.

Cardiac Arrest the Sudden Killer!

Most heart attacks are caused by a blockage in blood flow to the heart rather than a problem with the heart itself. Cardiac arrest is caused by an issue in the heart's electrical system and may not be a detectable condition leading up to the event.

 
Cardiac arrest is typically more severe than a heart attack, as it can result in death within minutes if proper medical care is not provided. Sudden cardiac arrest occurs when there is an electrical problem within the heart, rather than an obstruction in its supply lines.

 
With this electrical malfunction, the heart stops pumping oxygen-rich blood through the body, which puts organs at risk of damage including the heart itself. This results in loss of consciousness and can be fatal, or result in brain damage.

 
Each year, more than 350,000 people have an out-of-hospital cardiac arrest and about 90% of them are fatal and a disproportionate number are Blacks, according to the Centers for Disease Control and Prevention.

Blacks Die More from Sudden Cardiac Deaths

Researchers at the Smidt Heart Institute found that African-Americans in the U.S. experience sudden cardiac arrest at twice the rate as whites. Blacks have a higher incidence of out-of-hospital sudden cardiac arrest in comparison with whites, as evidenced in emergency medical service systems data in several US cities.

 
According to Jonathan Kim, M.D., director of sports cardiology and associate professor of medicine at Emory University, Black athletes in high-school, college, and the professional rank have higher rates of sudden cardiac arrest.

Know 3 Warning Symptoms ‘Signs’ Specific to Cardiac Arrest

Three signs of cardiac arrest that are not signs of a heart attack include sudden loss of consciousness, lack of pulse and no breathing.

 
Other symptoms, such as dizziness or chest pain, may also indicate cardiac arrest, but they may also be associated with other conditions, like a heart attack. Therefore, it is important to observe the entire range of symptoms before making any conclusions.

In the Case of Cardiac Arrest, Begin CPR first

When a person suffers from cardiac arrest, survival depends on them immediately receiving CPR. For adults, check for responsiveness, then call for help.

 
If two people are available to help, one should begin CPR immediately while the other calls 911 and finds an AED (Automated External Defibrillator) if available and use it as soon as possible. Continue high-quality CPR until professional emergency medical services arrive.

Compression-only CPR, or hands-only CPR, is a CPR in which continuous compression is given and no mouth-to-mouth breathing or rescue breaths. According to the American Heart Association, compression-only is the most effective form of CPR for adults and teens.

 
Black folks, with the super-alarming disproportionate number of our people with heart-disease including sudden cardiac deaths, every Black household should have someone trained in Compression-Only CPR to save lives.

Indeed, Compression-Only CPR is a basic life support skill that anyone can perform, regardless of their education, training, or

experience.

*Note: An Automatic External Defibrillator (AED) can be used by anyone, it is designed to be user-friendly even without CPR training.

Black Heart Disease Epidemic!

According to recent 2024 data from the American Heart Association, 60% of Black American adults have heart disease, and heart disease death rates are highest among Black Americans compared to other racial and ethnic groups.

 
Black men have a 70% higher risk of heart failure compared with white men; Black women have a 50% higher risk of heart failure compared with white women. Greater number of Blacks are dying from heart failure due to high levels of hypertension and diabetes.

Moreover, Black adults are more than twice as likely as white adults to be hospitalized for heart failure. They also spend longer in the hospital and are more likely to be admitted for the same issue again within 90 days.

Black women are more likely than white women to have a heart attack; Black adults are more likely than white adults to die from a heart attack. Black adults are more than twice as likely as white adults to be hospitalized for heart failure. Blacks also spend longer in the hospital and are more likely to be admitted again within 90 days.

Studies show that cardiovascular disease risk factors have substantially increased for Blacks 31-44. More Blacks have heart failure before their 50s; and more die from heart attacks and heat failure during their 50s.

Connected to this super-disproportionate rate of heart disease among Blacks, the American Journal of Cardiology (Aug 2024) reports that Black Americans suffered nearly 800,000 excess age-adjusted deaths and 24 million excess years of potential life lost due to cardiovascular disease from 2000 to 2022, compared with their White counterparts.

As a people we should be super-alarmed at the massive numbers of Blacks who have heart disease and die from it due to racism being a significant contributing risk-factor, yes we should be outraged by this chronic disease sickness and mortality crisis!

 
Indeed, Black folks we should be protesting out in the streets 'demanding' that this massive heart disease racial disparity be addressed now 'immediately' both by government on all levels and by us organizing in our communities around ‘heart health self-care responsibility’.

Blacks Have A Lot of Heart Disease But Few Black Heart Doctors

Recent data from the American Heart Association shows around 60% of Black American adults have heart disease, and heart disease death rates are highest among Black Americans compared to other racial and ethnic groups.

 
Indeed, Blacks are dominant when it comes to heart disease, yet its rare for them to be treated by a Black cardiologist. A 2021 report by the Association of American Medical Colleges found that only 4.2% of cardiologists are Black. 

An earlier study, published in 2019 in the journal JAMA Cardiology had similar findings, revealing that Black doctors made up only 3% of the cardiologist workforce. That same report found that 51% of cardiologists were white and 19% were Asian.

 
Moreover, a 2021 study in the Journal of General Internal Medicine found that the proportion of Black doctors in general in the U.S. had increased by only 4 percentage points over the last 120 years. 

The study also found that the share of Black male doctors remained the same since 1940. While there’s little data on the rates of Black women in cardiology, according to ‘The Lancet’ Black women make up only 2.8% of the physician workforce.

Report on Medical Access Finds One-Third of Black Americans Live in ‘Cardiology Deserts’

by Elaine Chen

Many Black Americans would have to travel across county lines just to find an open spot with a cardiologist, a new analysis found.

About 16.8 million Black Americans roughly 1 in 3 live in counties with little or no access to heart specialists, according to a report from GoodRx, a digital health company that provides drug discounts and also researches health trends.

When zooming in on counties that have sizable Black populations, the analysts found that 72% of these counties are “cardiology deserts,” most of them concentrated in southeastern states.

The findings illustrate the barriers to accessing care for a population that already faces a disproportionate burden from cardiovascular disease. It’s the leading cause of death in the U.S., and Black Americans face a 30% higher risk of death from heart disease than white people.

“We’re missing a huge chunk of individuals who really need this care and are having to jump through massive hoops to access that care,” said Tori Marsh, director of research at GoodRx. “When you have to jump through those hoops, you’re likely not going to.”

The analysts used data from Health Link Dimensions, a health data provider, to identify cardiologists across the country, and then mapped their locations to find which counties have cardiology deserts.

Prior research shows that counties with a high proportion of Black and Hispanic people already have less access to primary care doctors, often the first type of provider that people go to. 

But even if patients are able to get primary care, they would still need to see a cardiologist to address specific or urgent issues like heart failure and heart attacks, said Rishi Wadhera, a cardiologist at Beth Israel Deaconess Medical Center.

He noted that the report doesn’t account for how much access to telehealth services people have. But still, many services like cardiac stress tests can’t be performed remotely, said Wadhera, who’s also the section head of health policy and equity at the Smith Center for Outcomes Research.

The researchers also analyzed what the risk of heart disease looked like for people living in cardiology deserts. Using data on diabetes, obesity, smoking, unhealthy diet, physical inactivity, and excessive alcohol consumption, the researchers assigned a score of 0 to 6 to counties, with a higher number meaning a greater risk of heart disease in that county.

Compared with the national average of 2.9, the counties with sizable Black populations that had little or no access to cardiologists had average scores of 3.6 and 4.5, respectively. That means the areas where heart specialists are most difficult to reach are also where specialists may be most needed.

Wadhera said to address these deserts, the federal government could strengthen incentives to encourage medical graduates to pursue practice in communities that have less access to specialists.

Utibe Essien, an assistant professor of medicine at UCLA who researches health disparities, noted that research shows Black patients fare better under the care of Black doctors in particular, but there are also deep issues affecting the supply of Black doctors.

In the South, where most of the cardiology desserts have been identified, there are likely greater disparities in wealth and educational opportunities, and thereby more barriers for Black people to become doctors in their communities, he said.

“The regions that we’re missing a lot of cardiologists are in the South and are in states, cities that likely have high rates of segregation,” he said. 

Heart Disease Targets Black Americans and Poverty, Unemployment Are Big Reasons Why

By Cara Murez HealthDay Reporter

What researchers call 'social factors' are largely responsible for Black Americans having a greater risk of death from heart disease than whites, according to a new study.

Among the social factors that contribute to this racial disparity are unemployment, low income, lack of regular access to health care and lack of a partner, Tulane University researchers said.

“For so many years we have focused on smoking, diet, physical activity, obesity, [high blood pressure], diabetes and high cholesterol and we know those are important" for preventing heart disease, said lead author Dr. Jiang He, chair in epidemiology at Tulane University’s School of Public Health and Tropical Medicine in New Orleans. He added he was surprised that the Black-white difference in heart-disease death rates owes mainly to social factors.

Black Americans are 54% more likely to die of heart disease than white Americans, the study found. This is true even with a substantial overall reduction in heart disease deaths nationwide.

The study used health data from more than 50,000 U.S. adults. The researchers examined links between heart-related deaths and clinical risk factors like obesity, diabetes and high blood pressure as well as lifestyle factors, including smoking, unhealthy diet, lack of exercise and too little or too much sleep.

Researchers also considered social risk factors, such as unemployment, low income, food insecurity, limited education, lack of private health insurance, poor access to health care, and not being married or living with a partner.

Compared to white adults, Black adults had a 54% higher risk of heart-related death, which dropped to 34% after adjusting for clinical factors and 31% after adjusting for lifestyle risk factors. "However, after adjusting for social risk factors, this racial difference totally disappeared,” He said in a university news release.

This research follows another Tulane study that showed Black Americans are 59% more likely to die prematurely than white Americans. Adjusting for social factors referred to as social determinants of health reduced that gap to zero.

He said these findings underscore the importance of well-paying jobs, health care access and social support. He plans to put these findings into practice with a program that aims to address high blood pressure in New Orleans’ Black communities. It will partner with local churches to provide health screening training and free medication.

“It is essential to develop novel community-based interventions for reducing cardiovascular disease risk in Black populations,” He said.


*Study findings were published Aug. 15 in Annals of Internal Medicine.

New VCU-led Research Shows How Stress From Racism Influences Disparities in Heart Health

By Olivia Trani

Heart disease is the leading cause of death in the United States, yet the risk of death from this condition differs by race and ethnicity. Research has shown that Black adults are more likely to have poorer cardiovascular health compared with white adults and other minority groups. They are also more likely to develop risk factors for heart disease, such as obesity and high blood pressure, at an earlier age.

A new study led by Virginia Commonwealth University suggests that chronic stress from discrimination and adverse neighborhood conditions are some of the contributing factors behind this racial disparity. The research also found that the cardiovascular impact of these stressors varied by gender, with Black women more affected by discrimination and Black men more affected by neighborhood safety.

The findings, published in JAMA Network Open, could help providers and community partners better understand how certain stressors impact cardiovascular health within different groups, and thus could aid in the development of interventions. 

“Our goal was to understand what types of factors contribute to the stress experiences of Black people. If we can identify certain stressors to target in our mitigation strategies, we can hopefully improve cardiovascular health outcomes and reduce disparities in heart disease,” said Anika L. Hines, Ph.D., an assistant professor in the Department of Health Behavior and Policy at the VCU School of Population Health and lead author of the new study. Hines heads the Equity in Cardiovascular Health Outcomes Lab, which researches cardiovascular health disparities in Black communities.

Chronic stress and stress-related coping mechanisms are associated with increased heart disease. Experts believe that the cumulation of stress from a lifespan of structural and interpersonal racism may cause Black individuals to have differential stress-related health outcomes.

“We have these natural mechanisms in our body which respond to stressful situations, often referred to your fight-or-flight response. However, being persistently exposed to various stressors can throw your system off balance. Over time, the various systems that are supposed to help you during periods of stress can actually deteriorate your organ functioning,” Hines said.

For this study, Hines and her colleagues utilized data from the REGARDS project, a national study focused on better understanding geographic and racial differences in stroke mortality. They examined survey responses and clinical information collected from more than 7,500 participants.

To assess a person’s cardiovascular health, the researchers generated scores based on four health behaviors (cigarette smoking, diet, physical activity and body mass index) and three health indicators (blood pressure, cholesterol and glucose levels).

In their survey responses, participants reported how often they experienced racial discrimination, including at school, while receiving medical care or from the police. Participants were also asked about the condition of their local neighborhood, such as whether they feel safe, what the noise and traffic level is like and whether there is adequate access to grocery stores, parks and playgrounds. They additionally provided information about how connected they feel to their neighborhood, such as whether neighbors get along, trust one another, share the same values and are willing to help one another.

“We wanted to assess the various ways in which social and physical environments could impact an individual to see if we could understand which factors are contributing to the disparity. Social and economic determinants of health may feel so final that they can’t be adjusted, but these are often a result of policies,” Hines said.

The data showed that Black adults, especially Black women, had poorer cardiovascular health compared with white adults. While Black men had 27% lower odds of having better cardiovascular health than white men, Black women had 55% lower odds than white women - more than double the racial gap among men.

Compared with white participants, Black participants reported higher levels of perceived stress and more often reported instances of discrimination. Black participants also reported worse neighborhood conditions and more often reported that their neighborhoods were unsafe.

The data analysis showed that the disproportionate exposure to these stressors accounted for some of the racial disparity in cardiovascular health. According to the researchers’ calculations, stress from discrimination explained 11% of the racial difference in cardiovascular health between Black and white participants. Stress from neighborhood conditions also influenced this racial disparity, specifically the level of safety (6%), physical features (5%) and social connectedness (1%) within a neighborhood.

The research team discovered that the impact of these stressors varied by gender. Their results showed that discrimination explained 14% of the racial differences in cardiovascular health among women, while neighborhood safety attenuated these racial differences by 12% among men.

These findings suggest that public health approaches for reducing heart disease disparities may be more impactful by strategically targeting certain stressors. For example, addressing the unique stressors that tie into coping with discrimination could be more consequential in Black women, whereas addressing the impact of neighborhood violence may be more important for Black men.

“This study shows the importance of intersectional experiences when considering solutions for health disparities,” Hines said. “Marginalized groups aren’t monoliths. Even in the umbrella of marginalization related to race, there can be differential experiences based on gender, socioeconomic status and other factors.”

Hines and her colleagues are currently working with community members to design feasible interventions for young Black women to combat stress from these unique racial, gendered experiences with discrimination.

“We measure things so that we can do something about it. We hope that our findings help inform strategies, both in terms of policies and therapies, for dismantling these health disparities,” Hines said. “The more evidence we build in this field, the more improvements we can hopefully make in terms of structural change.

Lifestyle Marker Found in Black Adults May Signal Stroke Risk

An organic compound called gluconic acid could serve as a way to identify high blood pressure and stroke risk in Black adults, early research suggests.

By Don Rauf

Black adults may face a greater risk of high blood pressure and stroke if they are found to have a high level of an organic compound called gluconic acid in their body, according to preliminary research presented at the American Stroke Association’s International Stroke Conference 2023 in Dallas (held February 8–10). The study has not been published in a peer-reviewed journal.

“Whether gluconic acid causes high blood pressure or vice versa is yet to be determined in a future study,” says the lead study author, Naruchorn Kijpaisalratana, MD, PhD a research fellow in neurology at Massachusetts General Hospital in Boston. “We think that gluconic acid is a dietary related marker of inflammation, and those with higher stroke risk would have higher gluconic acid level.”

Marker Linked to Cardio Problems in Black but Not White Adults

For the study, Dr. Kijpaisalratana and colleagues examined blood samples collected from 1,075 ischemic stroke survivors during an average follow-up period of seven years. (In an ischemic stroke, a blood clot blocks or narrows an artery leading to the brain.)

Of those, 439 were Black adults and 636 were white adults. Their average age was 70, and participants were about 50 percent male and 50 percent female. The scientists compared these blood results with samples drawn from a group of nearly 1,000 Black and white adults who were similar in age but had not had a stroke. Samples were collected from participants over a four-year period from 2003 to 2007.

Elevated amounts of gluconic acid were found in the samples taken from Black adults who had high blood pressure, but not white participants with high blood pressure. Black adults with the highest gluconic acid levels were 86 percent more likely to have high blood pressure than those with low gluconic acid levels. Black adults with the highest gluconic acid levels also had a 53 percent increased risk of ischemic stroke, but no such association was seen in white participants.

A Biomarker Tied to Lifestyle Practices

The results suggested that higher gluconic acid levels among the Black participants may be related to lifestyle habits — such as consuming foods high in fats, fried foods, processed meats, and sugary drinks (which are often part of a “Southern diet”), as well as a lack of physical activity. Kijpaisalratana added that education levels may also be associated with lifestyle and health behaviors.

“We hypothesize that the changes in behavior including eating a healthy diet and more physical activity would lower gluconic acid levels,” she explains. “But this would require another experimental study to confirm our hypothesis.”

Why Scientists Focused on Gluconic Acid

Gluconic acid is a type of metabolite. Metabolites are substances made or used when the body breaks down food, drugs, chemicals, or its own tissue (for example, fat or muscle tissue). Past research has demonstrated that metabolites are linked to oxidative stress – a condition that may occur when there are too many unstable molecules called free radicals in the body and not enough antioxidants to get rid of them. A growing body of evidence suggests that oxidative stress may play a role in the development of hypertension.  

The researchers focused on gluconic acid after screening 162 metabolites that are relevant to human metabolism; they found that gluconic acid was the only metabolite that demonstrated racial differences.

“What surprised us was that we identified a metabolite that has racial differences in association with the diseases, and this metabolite was linked to social determinants of health including diet, education, and exercise,” said Kijpaisalratana.

Gluconic acid may be considered a dietary-related marker because of its availability in foods (such as fruits, wine, and honey), and it is potentially produced by the gut microbiome, according to study authors. They emphasized that gluconic acid at this point is just a marker of inflammation, and has not been proven to be a cause.

“Our findings did not demonstrate that gluconic acid by itself is harmful,” says Kijpaisalratana. “We demonstrated that gluconic acid could be a marker that links to several health behaviors. Therefore, we suggest that people should maintain their healthy lifestyle through eating healthy and exercising regularly.”

A Potential Tool to Identify Heart Disease Risks

Bruce Oybiagele, MD an associate dean and professor of neurology at the University of California in San Francisco and an American Heart Association expert volunteer, notes that gluconic acid could be a helpful tool for healthcare providers in spotting Black adults who are in danger of having a stroke.

“Given the long-standing higher risk of stroke in Black compared to white adults in the United States, which is so far still not fully explained by a higher frequency of traditional stroke risk factors, the potential discovery of a new prognostic marker or therapeutic target is extremely important,” says Dr. Ovbiagele, who was not involved in the study.

He added that gluconic acid might “serve as an objective measure to inform healthcare professionals about how well their patients are doing in reducing hypertension and stroke risk and may also be helpful to motivate Black patients to modify their lifestyles as appropriate to prevent stroke”