Magnesium and Black Hearts

by Kenny Anderson

Magnesium is essential to heart health and the prevention of cardiovascular disease. Magnesium is needed to support the electrical activity of the heart, keeping the heart beating over 30 million times a year. Magnesium is also needed for blood pressure regulation and heart rhythm control. 

Magnesium deficits have been linked with cardiovascular disorders: high blood pressure, heart rhythm problems such as atrial fibrillation, cholesterol-clogged coronary arteries, painful spasms of coronary arteries, and sudden cardiac arrest (heart attack). 

Numerous studies show that most Americans are not getting enough magnesium in their diet. Studies shows a staggering 68% of Americans do not consume the recommended daily intake of magnesium 310–420 mg and 19% of Americans do not consume even half of the government’s recommended daily intake of magnesium.

Research has shown that people with a higher intake of magnesium have a lower risk of heart disease. Studies have also revealed that the higher your blood level of magnesium the lower your risk of coronary artery calcification. 

Recent studies cite that low magnesium levels have been found to be the best predictor of heart disease, contrary to the traditional belief that cholesterol or saturated fat play the biggest roles.

Additionally, it has been discovered that higher levels of magnesium are associated with lower levels of the inflammatory marker C-reactive protein which is linked to heart problems. Blacks have the highest rate of heart problems in America; over 40% of Black men and women have heart disease.

Blacks High Level of Chronic Stress and Low Levels of Magnesium

Blacks in America definitely are not getting enough magnesium due to poor diets (over consumption of processed foods) and the depletion of magnesium due to chronic stress. 

Blacks are the most oppressed racial group in America, suffering more chronic stress from institutional racism. Chronic distress includes unending feelings of despair - hopelessness, anger, shame, worry, and grief; poverty, family dysfunctional stress, traumatic experiences, experienced and perceived racial discrimination, neighborhood stress, daily stress, acculturative stress, and environmental stress.

Indeed, chronic stress depletes your body of magnesium leading to magnesium deficiency; the greater your level of stress, the greater the loss of magnesium. Living under constant conditions of mental or physical stress causes magnesium to be released from your blood cells and goes into the blood plasma; from there it's excreted into the urine. 

The lower your initial magnesium level is, the more reactive to stress you become, and the higher your level of adrenaline in stressful situations. Higher adrenaline causes greater loss of magnesium from cells creating a vicious cycle.

Heart health benefits of magnesium include but are not limited to:

*Preventing arrhythmias (irregular heartbeats such as atrial fibrillation)

*Keeping blood vessels healthy

*Supporting normal blood vessel dilation and contraction

*Helping to reduce damage to the heart from oxidative stress

*Boosting the good HDL cholesterol

*Protecting against Type 2 Diabetes

*Anti-inflammatory action

What Are Cardiac Symptoms of a Magnesium Deficiency?

*Heart arrhythmias like atrial fibrillation, PAC’s and PVC’s.

*Elevated blood pressure

*Inflammation

*Blood sugar imbalances

What Are Other Symptoms of a Magnesium Deficiency?

*Insomnia

*Fatigue

*Muscle pain

*Anxiety or stress

*Headaches and migraines

Some Foods High in Magnesium

*Fatty Fish (salmon, mackerel, halibut) 

*Greens (collard, mustard, turnips; kale, spinach)

*Bananas

*Nuts (Brazil nuts, almonds, cashews) 

*Seeds (flax, pumpkin, chia)

*Legumes (beans)

*Avocados

What Are the Best Forms of Magnesium for the Heart?

Of the nine common forms of magnesium there are five that are imperative to heart health. These are magnesium malate, magnesium citrate, magnesium taurinate, magnesium bisglycinate chelate, and magnesium orotate:

*Magnesium Malate: This form consists of magnesium combined with elemental malic acid. This type of magnesium is well absorbed and supports energy levels. Malic acid supports energy production in cells and aids in detoxing heavy metals from the body. It is a highly bioavailable form to support blood pressure, heart rhythm, inflammation and nerve function.

*Magnesium Citrate: This form is magnesium bound to citric acid. It has a high absorption level. It is good for sleep and heart muscle relaxation. It aids in supporting digestion and improving constipation. Again, it is highly bioavailable to support blood pressure, heart rhythm and the heart muscle.

*Magnesium Taurinate: This form, consisting of magnesium and the amino acid taurine, is highly bioavailable to the cells. This form is exceptional for the heart as both the magnesium and taurine can improve the function of the heart muscle. This form can increase ATP (energy) production in the cell, which protects the heart muscle. This type also reduces blood pressure and increases insulin sensitivity, further protecting the heart.

*Magnesium Bisglycinate: This form of magnesium consists of magnesium and the amino acid glycine. It has a high absorption rate. It is also good for sleep and muscle relaxation. It has a calming effect on the nervous system.  This type is chelated and stable so it has a non-laxative effect. Due to its high absorption level, it is helpful in regulating blood pressure, heart rhythms and the cellular activity of the heart muscle.

*Magnesium Orotate: Magnesium orotate is a compound made up of magnesium and orotic acid. This is one the most effective forms of magnesium for heart health. This form can actually penetrate cell membranes and deliver magnesium to the innermost compartments of the cells. It is needed for heart health as it can deliver magnesium to these cells and help with recovery of these tissues. It is also the best way to reverse magnesium deficiencies. Together, all five of these forms work to support the electrical activity of the heart and aid in normal blood pressure regulation.

As Black folks we must understand that our heart muscles has one of the highest needs for magnesium; our hearts need high-quality magnesium to function properly. Due to poor diets and high levels of chronic stress we need to request that our Primary Care Physicians do blood work to check our magnesium levels. Moreover we need to learn and practice stress management, increase eating foods with high levels of magnesium, or take magnesium supplements.  

Post-Traumatic Stress Disorder Strikes One in Eight Heart Surgery Patients

By Anne Curley

Post-Traumatic Stress Disorder (PTSD) usually is associated with military personnel traumatized by combat or people who’ve been victimized by violent crime or sexual assaults.

But new study finds that one in eight patients develop PTSD after experiencing a heart attack or other major heart event. The study, published online in PLoS One, also reveals that heart patients who experience PTSD face double the risk for another heart event or dying within one to three years, compared to heart patients who do not experience PTSD.

Scientists from Columbia University Medical Center performed the first meta-analysis of studies examining PTSD induced by major heart events. The studies included almost 2,400 patients who experienced acute coronary syndrome or ACS, an umbrella term medical professionals use to describe any condition that reduces blood flow to the heart, including heart attacks and unstable angina.

“Everybody is expected to have some disruption after a life threatening event such as a heart attack,” explained lead study author Donald Edmondson, assistant professor of behavioral medicine at Columbia University Medical Center, “but after a month we expect people to mostly get back to normal.” Edmondson said their research focused on studies of patients who experienced symptoms of PTSD more than one months after their heart event.

“These studies measured PTSD symptoms intrusive thoughts about the heart attack – out of nowhere that sort of fight or flight response to these memories. People also have nightmares about the event, they have sleep disruptions, they actively avoid thinking about the heart attack, they try to manage their thoughts,” said Edmondson.

More than 1.4 million people in the U.S. are discharged each year from hospitals after suffering acute coronary syndrome, explained Edmondson, If 12% of those patients experience clinically significant symptoms of PTSD, that means that 168,000 patients could experience PTSD each year after heart events.

While medical professionals are keenly aware of the association that has been shown between depression and heart attacks, Edmondson believes that making patients, their families and medical professionals aware of the incidence of PTSD after heart events is critical.

Edmondson said when he’s discussed findings about PTSD with cardiologists, they’ve told him 'I thought these were funny depression symptoms. I knew there was something wrong here but I didn’t have a language for it.'  

Edmondson said that while PTSD and depression often travel together, "PTSD symptoms are unique – the experience of intrusive thoughts, the nightmares, the inability to shake thinking certain thoughts, the fight or flight symptoms are unique to PTSD. For a patient or a cardiologist who’s not looking for PTSD, once you know the symptoms, they sort of jump out and they’re unique to PTSD."

“Despite the variation in the estimates of the prevalence PTSD appears to be a reasonably common occurrence after ACS and seems to be associated with worse outcomes,” said Dr. Gordon F. Tomaselli, president of the American Heart Association.  "Further study is warranted but practitioners need to be alert to the possibly of PTSD after ACS and should institute treatment.”

“Physicians and patients have to be aware that this is a problem. Family members can also help,” said Edmondson.  "There are good treatments for people with PTSD,” Edmondson noted, explaining that the best treatment is an “exposure based talk therapy," in which the patient talks about the traumatic experience, reliving it in an effort to desensitize them to the event.

Study Finds Black Communities Suffer from Higher Comparative Rates of Sudden Cardiac Death Than White Ones

By Kiersten Willis

New research from the American Heart Association reveals an explanation as to why Black communities see higher rates of sudden cardiac arrest death especially between women than white ones.

Findings from a study by the Atherosclerosis Risk in Communities (ARIC) revealed that by age 85 Black men account for 9.6 percent of people who suffered sudden cardiac deaths, while 6.6 percent of sufferers were Black women. 

Comparatively, white men accounted for 6.5 percent of sudden cardiac arrest deaths, while white women made up 2.3 percent of such victims. These numbers show Black men had a sudden cardiac death rate nearly 48 percent higher than that of white men, while Black women’s death rate was 187 percent higher than white women’s.

The study, which was conducted over the course of nearly three decades and published in AHA’s journal Circulation, revealed that Blacks’ higher comparative rates are the results of differences at a cultural and socioeconomic level, including disparities in education and income. Additionally, risk factors like hypertension and diabetes are to blame.

The ARIC study collected its data by focusing on four American communities — the suburbs of Minneapolis, Forsyth County in North Carolina, Washington County in Maryland, and Jackson, Mississippi. White participants made up 11,237 of those reviewed, while 3,832 Black participants were involved in the research.

Yet despite the findings, which were discovered over a significant span of time, lead researcher Eliseo Guallar, Ph.D., acknowledged more studies need to be conducted.

“Low income and lack of education are associated with unhealthy behaviors, low disease awareness, and limited access to care, which could all contribute to poor outcomes,” Guallar said in a press release. “However, our understanding of the mechanisms for racial differences in sudden cardiac death is still incomplete and additional research is needed.”

Still, there are some solutions available to assist Black communities with combating the findings of the ARIC. Dr. Icilma Fergus, associate professor of medicine at Mount Sinai Medical Center in New York City, told Healthline that she’s working with communities in the area to teach them about how to spot and treat symptoms and promote heart health. 

Dr. Fergus co-founded and co-directs the Healthy Heart Series program, which provides workshops and training to assist people in learning simple ways to look after themselves and to prevent and heart disease and sudden cardiac arrest.

“It’s about creating a trusting situation where people learn from and gravitate to providers they trust, gain the knowledge, and ultimately do it for themselves,” she said. “When I started working in central Harlem, I found that people weren’t as trustful of doctors at first. We started out with 10 or 20 people in the monthly workshops, now we have 90 on average.”

Along with taking proper medications, it’s also important for people to have access to healthier food options, which is not always the case in areas where food deserts are common. Such issues disproportionately affect Black communities. 

However, Fergus noted that getting ingredients for quality meals can be done through a community farmers market without resorting to an expensive health foods store.

Micro-vascular Angina: a Puzzling Form of Chest Pain and Unrecognized Danger

It's more common in women than men and often goes untreated

by Vinita Subramanya, M.B.B.S, M.P.H. and Erin Michos, M.D., M.H.S.

A type of cardiovascular disease known to physicians as micro-vascular angina affects the heart's tiniest arteries and causes chest pain. The disease is sneaky, in that it doesn't show up on traditional heart scans but is linked to serious health outcomes, like heart attacks. 

Here is what you need to know about micro-vascular angina, which is often unrecognized and under-treated and more common in women than men.

What Is Micro-vascular Angina?

When the oxygen supply to the heart muscle tissue cannot meet the heart's metabolic demand, it can sometimes (but not always) cause chest pain, known as angina. The more common form of angina is from blockages in the heart's arteries due to buildup of cholesterol plaque a condition called obstructive coronary artery disease that limits blood flow to the heart.

Physicians frequently evaluate people with chest pain by stress testing and sometimes with an angiogram a type of X-ray in which dye is injected into the heart's arteries to see blockages or narrowing. This test can help determine what type of treatment is needed.

But many individuals with angina don't show obstructions or blockages in their heart arteries when evaluated by an angiogram. This problem of chest pain without obstructive coronary artery disease or micro-vascular angina may be caused by problems with the small arteries of the heart instead of the large ones visualized in the traditional scans.

Mechanisms that contribute to micro-vascular angina aren't fully understood, but some potential causes have been identified. It can be due to temporary spasms of the larger heart arteries or from abnormal functioning of the endothelial cells that line the heart arteries.

Endothelial cells release chemicals that relax and contract the small arteries. This chemical release can become imbalanced in a diseased heart. Risk factors such as smoking, diabetes and inflammation can often cause these endothelial cells to malfunction. Patients with micro-vascular angina may also have an increased sensitivity to pain due to certain substances released from these cells.

What Are the Signs and Symptoms?

Micro-vascular angina, formerly known as cardiac syndrome X causes a constellation of symptoms and signs that include chest pain during physical exertion, signs of reduced blood supply to the heart as determined by stress testing or advanced cardiac imaging, and normal-appearing arteries on an angiography of the heart.

Micro-vascular angina diagnosis is often missed because it can show up in a more unusual fashion than chest pain from obstructive coronary disease. For example, micro-vascular angina episodes can occur during times of mental and emotional stress or even at rest, rather than just physical exertion; episodes can last longer than those from obstructive coronary disease, and they respond less well to standard therapies, like nitroglycerin.

Micro-vascular angina symptoms can sometimes be falsely blamed on other causes, like stress and anxiety, panic attacks or gastrointestinal troubles. For many years during chest pain assessments, physicians only looked for signs of obstructive coronary artery disease, and they dismissed chest pain if they found no obstruction. This led to missed opportunities for implementing the appropriate treatments for this condition.

Both men and women can develop micro-vascular angina, but it's much more common in women. Among patients with stable chest pain about 41 percent of women versus 8 percent of men show no large artery obstructions on angiograms.

Why Is Micro-vascular Angina Serious?

While micro-vascular angina is usually a stable condition, women are twice as likely as men to have normal-looking heart arteries (without apparent blockages) when they actually have a heart attack. This unusual type of heart attack is called myocardial infarction with non-obstructed coronary arteries, or MINOCA.

Spasms in the blood vessels can be one potential cause. In many instances, a special type of heart ultrasound can confirm plaque in the heart arteries that had eroded or ulcerated. These heart arteries aren't 'normal' despite the absence of blockages.

The Women's Ischemia Syndrome Evaluation, sponsored by the National Heart, Lung, and Blood Institute, was a landmark study that began back in 1996 and enrolled over 900 women with signs and symptoms of heart disease who underwent a coronary angiogram.

The outcomes of these women followed for more than a decade have contributed much of the knowledge that we know today about micro-vascular angina, including some of the mechanisms behind this puzzling condition and its long-term risks. 

For example, the WISE study found that the heart's arteries react with abnormal patterns of narrowing and relaxing in women with micro-vascular angina. More importantly, the WISE study concluded that even without evidence of major heart artery obstructions, micro-vascular angina is worrisome.

Patients with angina but without obstructed arteries still have increased rates of heart attacks, strokes, heart failure and death compared to women without angina. This is magnified among women with more cardiovascular risk factors. Micro-vascular angina increases death rates by 1.5-fold. People with angina also have higher hospital readmission rates for chest pain and repeat coronary angiographies.

The WISE study led to great improvements in diagnosing and treating micro-vascular angina, but gender differences still exist in the clinical outcomes, with women still being under-diagnosed and under-treated.

How Do We Test for Micro-vascular Angina?

Since we can't determine the causes of chest pain solely from the symptoms, we look to additional ways of diagnosing angina. Physicians classify symptomatic women by their risk as either low, intermediate or high, and evaluate them based on cardiovascular risk factors.

Low-risk women don't usually need further testing. Low to intermediate and intermediate-risk women should be further evaluated using an exercise treadmill test that measures a woman's exercise capacity and an electrocardiogram that measures electrical activity of the heart.

Intermediate to high-risk women with an abnormal ECG will need further imaging using any of the following techniques: myocardial perfusion imaging (or nuclear stress testing), stress echocardiography and cardiac MRI or cardiac CT-angiography.

High-risk women may be given a traditional coronary angiogram which may even be paired with an invasive test considered a gold standard the coronary flow reserve measurement. The coronary flow reserve test measures how much the heart arteries can dilate and increase blood flow above the normal volume when given a specific drug that relaxes the arteries. Revealing the exact cause of the micro-vascular dysfunction requires more in-depth testing.

How Do We Treat Micro-vascular Angina?

An important step to improve outcomes among women with micro-vascular angina is to recognize that they are at risk for some of the same outcomes as people with obstructive coronary disease. Physicians' treatment goals include a combination of strategies aimed to both increase blood flow and reduce workload in the heart.

While there aren't set regimens to treat micro-vascular angina, two therapeutic mainstays use medications that aim to improve chest pain and prevent plaque buildup in the arteries. Responses to treatments aren't consistent among men and women and may be related to the differences in the disease mechanisms. Anti-angina medications are used to improve symptoms of chest pain. 

These include beta blockers that improve the heart's blood flow by reducing its workload, calcium channel blockers that improve the blood flow and decrease blood pressure (thereby further reducing the workload) and nitroglycerin that works to improve blood flow. 

Aspirin prevents clot formation and decreases inflammation. Other newer drugs act on the heart's cellular processes and improve their functioning during temporary periods of low blood flow.

Other medications to treat micro-vascular angina include statins that lower cholesterol levels and prevent cholesterol from building up in the arteries, and the angiotensin converting enzyme inhibitors that improve the function of the endothelial cells lining the heart's arteries. 

Newer therapies under investigation include the class of drugs known as phosphodiesterase inhibitors that act at the cellular level and transcutaneous electrical nerve stimulation, both of which improve arterial blood flow.

How Do We Prevent Micro-vascular Angina?

The well-established (and largely preventable) risk factors that contribute to obstructive coronary disease such as high blood pressure, high cholesterol, diabetes, smoking and sedentary lifestyle are just as important for developing micro-vascular angina. 

Autoimmune conditions like rheumatoid arthritis and lupus may also raise the risk of developing micro-vascular angina. And young women with lower than normal levels of estrogen are at risk. 

Prevention strategies include reducing one's risk through appropriate medical and lifestyle changes, like controlling high blood pressure, cholesterol and blood sugar levels. Improvements in diet and physical activity levels can go a long way in reducing micro-vascular angina frequency.

People should eat a diet rich in omega-3 fatty acids, fruits, vegetables and whole grains, and minimize processed foods and foods with higher saturated fat, sodium and refined sugars. 

It's important to maintain a healthy weight and better manage stress levels through physical activity, stress management, relaxation programs, and meditation. Quitting smoking also should be a top priority.

Take-Home Points:

1) Micro-vascular angina is a form of chest pain due to abnormalities in the tiny arteries of the heart that cause decreased blood flow.

2) Since micro-vascular angina occurs in the absence of blockages or obstructions in the large heart arteries, it is often under-recognized and under-treated.

3) If you have chest pain after exerting yourself and get an abnormal result on a stress test but have no evidence of blockages on an angiogram, it is likely you have micro-vascular angina.

4) Women have this condition more often than men, and their symptoms can be different from men's symptoms.

5) People with micro-vascular angina have an increased risk of heart attacks and death in the next five years compared to patients without angina symptoms.

6) Controlling risk factors, such as not smoking, as well as managing blood pressure, blood sugar and cholesterol and other blood fats, are important for preventing and controlling symptoms of this disease.

7) Eating a healthy diet and getting plenty of physical activity are also very important for preventing and treating micro-vascular angina

Barbershop Blood-Pressure Intervention Benefits for Black Males Sustained

Community-Based Hypertension Intervention has Lasting Benefits Trial Follow-Up Shows 

by Kate Kneisel, Contributing Writer, MedPage Today 

The success of a barbershop intervention to tackle uncontrolled blood pressure (BP) among African-American men persisted at 12 months, mirroring 6-month findings of the randomized trial.

Mean systolic pressure was 28.6 mm Hg below baseline at 12 months in the intervention group compared with the 7.2 mm Hg reduction in the control group (P<0.0001), with end levels of 123.8 vs 147.4 mm Hg, reported Ciantel Blyler, PharmD, of Cedars-Sinai Medical Center in Los Angeles, and colleagues online in Circulation.

Mean diastolic BP reduction was 14.5 mm Hg greater in the intervention group (P<0.0001). Substantially more intervention participants got below 130/80 mm Hg (68.0% vs 11.0%, P=0.0177).

The BP reductions at 12 months "are statistically indistinguishable from our previously reported 6-month data, despite less interactions with the pharmacists in the second 6 months of the trial (7 ± 2 visits vs 4 ± 2)," the group wrote. 

"The observed 90% cohort retention, few treatment-related adverse events, improved patient satisfaction and self-rated health strongly suggest sustainability of our hypertension detection and treatment model."

John Bisognano, MD, of the University of Rochester, New York, told MedPage Today, "The results were phenomenal, and likely represent one of the greatest innovations in healthcare delivery for hypertension in the past 30 years."

"So much of our hypertension management is focused on lifestyle modification and drug selection and follow-up," said Bisognano, who was not involved in the study. "While this approach has been successful over the past half-century, treatment and control rates have largely stalled, and this approach has been particularly ineffective in non-Hispanic black men who continue to have high rates of suboptimally treated hypertension."

Khadijah Breathett, MD, of the University of Arizona in Tucson, commented, "This landmark study heralds the need to engage community members where they live. Health equity will require moving beyond the confines of the ivory tower of medicine." Breathett was not involved in the study.

The trial included 319 African-American men, ages 35-79, with baseline systolic BP over 140 mm Hg at two screenings. They were cluster randomized to 52 barbershops in the Los Angeles area, which had been randomly assigned to study arm. Mean systolic BP at baseline was similar between intervention and control groups (152.4 mm Hg and 154.6 mm Hg, respectively). A higher percentage of the intervention group reported high cholesterol.

The 6-month extension of the study kept the same randomization and protocols. The intervention provided BP management to patrons in their barbershops was not only more convenient, but also helped address distrust and avoidance of the medical profession by using trusted barbers who they had visited on average every 2 weeks for over a decade to deliver health messages, the researchers noted. 

Men randomized to the active arm saw pharmacists certified by the American Society of Hypertension, who under an agreement with participants' primary care providers, monitored their BP, as well as plasma electrolytes and creatinine; provided lifestyle recommendations; and prescribed a combination antihypertensive drug regimen following a generally fixed set of medication adjustments. 

The long-acting thiazide-type diuretic indapamide was the preferred third-line drug, followed by an aldosterone antagonist if needed. Only 50% of regimens required three or more drugs. 

The control group received instruction about BP and lifestyle modification. Barbers were trained to encourage participants in each group accordingly. The researchers attributed the success of the intervention to use of more intensive therapy and combination regimens, more first-line BP drugs, and more long-acting drugs. 

Study limitations included the fact that assignment through cluster randomization could not be blinded but was independently assessed, and the use of financial incentives in both the intervention and control groups ($25 vouchers monthly for haircuts or pharmacist visits, respectively), which reportedly had a small but not insignificant effect on medication adherence. 

Also, use of a BP goal of under 130/80 mm Hg was lower than the 140/90 target used at the time by most community physicians. "Our results indicate that our new model of [hypertension] care can succeed in reaching high-risk hypertensive populations and markedly improve control rates with simple treatment algorithms, frequent follow-up and persistence in adjusting therapy when blood pressure remains above goal," the group noted. 

"Perhaps the most critical first step towards widespread dissemination of our model is the expansion of collaborative practice between pharmacists and physicians, or the elimination of the requirement altogether (as in Canada and the U.K.)." 

First author Ronald Victor, MD, also of Cedars-Sinai, passed away shortly before submission of the paper. "This innovative work represents a great and lasting innovation from a beloved figure in the hypertension community - a prolific researcher both in the clinical and basic science realms, a teacher and a scholar, whose legacy includes revolutionizing how hypertension treatment rates can be tremendously increased by focused community interventions," Bisognano said.

U.S. Cities with the Highest Heart Disease Rates Have High Black Populations

In the United States, heart disease is the top killer, leading to 610,000 deaths a year, or one in every four fatalities. Blacks have the highest rates of heart disease in the U.S. – over 40% of Blacks have heart disease.

Recently heart health writer Hristina Byrnes wrote an article listing the cities with highest rates of heart disease. To identify the heart disease capitals in the United States, 24/7 Wall St. reviewed data from the Centers for Disease Control and Prevention for the largest 500 cities in the country. 

The 20 cities listed are those where at least 7.5% of people over 18 years of age report having been told by a health professional that they had angina or coronary heart disease in 2015. 

Additional data came come from the CDC’s Behavioral Risk Factor Surveillance System data, and the Census Bureau’s 2017 American Community Survey.

Below is the listing of the top 11 cities with heart disease, out of these eleven cities 81% had Black populations of over 40%, six of the cities had Black populations over 54%.

Flint, Michigan

> Heart disease incidence: 8.7%
> Current lack of health insurance: 21.8%
> Smoking: 31.5%
> Obesity: 42.0%
> Adults who report poor physical health: 18.9%

> Black population 57%

The lead contamination crisis in Flint may help partially explain why the city has the highest share of heart disease incidence of any major city. Chronic exposure to lead and higher concentrations of lead in blood cause hypertension, ECG abnormalities, peripheral arterial disease, and cardiovascular disease. Flint has the highest rates of arthritis (34.9%), asthma (13.4%), chronic obstructive pulmonary disease (10.9%), and smoking (31.5%) - all of which significantly increase the risk of heart disease.

2. Detroit, Michigan

> Heart disease incidence: 8.6%
> Current lack of health insurance: 23.6%
> Smoking: 31.4%
> Obesity: 45.1%
> Adults who report poor physical health: 18.7%

> Black population 84%

Among the 500 largest U.S. cities, Detroit has the third highest adult diabetes rate, the second highest arthritis and obesity rates, and the highest rates of high blood pressure and smoking. Also, Detroit is No. 2 in people with asthma, which has been linked to a 57% higher risk of heart disease.

3. Reading, Pennsylvania

> Heart disease incidence: 8.6%
> Current lack of health insurance: 31.5%
> Smoking: 26.3%
> Obesity: 43.8%
> Adults who report poor physical health: 19.4%

> Black population 9%

Of the seven cities in Pennsylvania on the list, Reading is the only one where the rate of heart disease went up between 2014 and 2015, although by just 0.1 percentage point. The city's problems with heart disease extent to wider health issues. Among Reading adults, 19.1% report at least 14 days of poor health per year, the highest share of all 500 cities in the database.

4. Youngstown, Ohio

> Heart disease incidence: 8.5%
> Current lack of health insurance: 21.0%
> Smoking: 30.6%
> Obesity: 40.6%
> Adults who report poor physical health: 18.7%

> Black population 45%

Youngstown was No. 1 on the list of cities with the highest rates of heart disease in 2014. The slight improvement of 0.1% brought it down to fourth place a year later. A combination of several factors associated with heart disease help keep the city in the top five, including a high rate of chronic obstructive pulmonary disease, at 10.8% of adults - the second highest among the 500 largest U.S. cities. COPD is linked to a higher risk of heart conditions due to elevated pulse rates during both rest and exercise.

5. Dayton, Ohio

> Heart disease incidence: 8.4%
> Current lack of health insurance: 17.1%
> Smoking: 27.5%
> Obesity: 39.7%
> Adults who report poor physical health: 17.7%

> Black population 43%

Cardiovascular disease accounts for 37% of all deaths in the state, compared with a quarter of deaths nationwide. The Ohio Department of Health supports several initiatives to reduce the risk, and they may have been a factor in the positive effect between 2014 and 2015. All nine cities in Ohio on the list had a decrease in the incidence of heart disease. Dayton's share fell by 0.2 percentage points, which was not enough to keep the city from having one of the five highest shares among the nation's major cities.

6. Gary, Indiana

> Heart disease incidence: 8.3%
> Current lack of health insurance: 23.3%
> Smoking: 26.9%
> Obesity: 45.2%
> Adults who report poor physical health: 18.3%

> Black population 81%

Of all 500 cities on the list, Gary has the highest rate of diabetes - 18.4%; the second highest stroke rate among adults - 5.9%; and the third highest rate of people with high blood pressure. Hypertension can lead to hardened arteries, stroke, or heart attack because the force with which the heart is pushing blood through arteries is too high.

7. Camden, New Jersey

> Heart disease incidence: 8.3%
> Current lack of health insurance: 30.3%
> Smoking: 26.8%
> Obesity: 40.9%
> Adults who report poor physical health: 19.4%

> Black population 42%

In Camden, 41.8% of adults have high blood pressure, the ninth highest share among major cities and well above the 29.4% of American adults who do. Almost 45% of adults in the New Jersey city don't exercise in their spare time -- the highest rate of lack of physical activity on the list. Also, Camden has the second highest rate of adults with diabetes. The city is also in the top 10 for obesity among adults.

8. Cleveland, Ohio

> Heart disease incidence: 8.2%
> Current lack of health insurance: 19.9%
> Smoking: 28.3%
> Obesity: 40.1%
> Adults who report poor physical health: 17.9%

> Black population 53%

Cleveland has a high rate of adults who have had a stroke - 5.3%, the sixth highest share among major cities. Also, many city residents smoke too - 28.3%, the fourth highest share. High blood pressure is also very common in the city - almost 69% take medication for it, the ninth highest share among major cities.

9. Macon, Georgia

> Heart disease incidence: 7.9%
> Current lack of health insurance: 25.5%
> Smoking: 25.8%
> Obesity: 41.2%
> Adults who report poor physical health: 17.9%

> Black population 68%

Macon is in the top 20 for many health conditions that pose a high risk for developing heart disease. One that particularly stands out is stroke. Close to 6% of the adult population have had a stroke, the third highest rate among the 500 largest U.S. cities. Stroke is associated with coronary heart disease because both share common risk factors, such as high LDL (bad) cholesterol, high blood pressure, diabetes, and being overweight.

10. Canton, Ohio

> Heart disease incidence: 7.7%
> Current lack of health insurance: 15.7%
> Smoking: 27.8%
> Obesity: 38.3%
> Adults who report poor physical health: 16.6%

> Black population 24%

Canton also has a high proportion of adults with arthritis the sixth highest on the list but it also has a large number of people smoking over 10%, the fourth highest rate. Smoking is a major contributor to coronary heart disease because the chemicals in the smoke cause the blood to thicken and form clots, blocking circulation.

11. Birmingham, Alabama

> Heart disease incidence: 7.6%
> Current lack of health insurance: 19.8%
> Smoking: 24.6%
> Obesity: 42.7%
> Adults who report poor physical health: 16.4%

> Black population 74%

About a third of adults in Birmingham have arthritis. Similarly to heart disease, arthritis is an inflammation process. This is why people with arthritis are at a greater risk of developing heart disease, including irregular heartbeats, high blood pressure, heart failure and plaque in the arteries. More than half of premature deaths in people with rheumatoid arthritis result from cardiovascular disease.

Over Half of All African-American Adults Will Have Hypertension With New Diagnostic Guidelines

*Info from American Heart Association

Well over half of all African-American adults will be classified as having high blood pressure under new streamlined diagnostic guidelines illuminating the heavy burden of cardiovascular disease in the population. 

Anyone with blood pressure higher than 130/80 will be considered to have hypertension, or high blood pressure, the American Heart Association and American College of Cardiology stated Monday in releasing their new joint guidelines. That changes from 140/90, where the diagnostic guideline had been since 1993.

“Rather than one in three U.S. adults having high blood pressure (32 percent) with the previous definition, the new guidelines will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, or hypertension,” the groups stated.

With the change, it is estimated that 59 percent of all African-American men will be classified as having high blood pressure, up from 42 percent. Fifty-six percent of African-American women - who had the highest rate previously at 46 percent - now have high blood pressure. Forty-seven percent of white men and 41 percent of white women have high blood pressure.

“Earlier intervention is important for African-Americans,” said Dr. Kenneth A. Jamerson, a guideline author, cardiologist and professor of cardiovascular medicine with the University of Michigan Health System.

“Hypertension occurs at a younger age for African-Americans than for whites. By the time the 140/90 is achieved, their prolonged exposure to elevated blood pressure has a potential for worse outcome.”

Heart disease also develops earlier in African-Americans and high blood pressure plays a role in more than 50 percent of all deaths from it. African-Americans have a higher rate of heart attacks, sudden cardiac arrest, heart failure and strokes than white people. 

In addition, the risk for African-Americans is 4.2 times greater for end-stage renal disease, which often progresses to the need for dialysis multiple times a week and ultimately to kidney transplantation or death.

“Hypertension has been a blight on the African-American community for many, many years. It’s time for us to get over it,” said Dr. Kim Allan Williams Sr., chief of cardiology at Rush University Medical Center in Chicago. “People need to get screened and get care.”

The new guidelines are expected to offer new ways for medical providers to work with patients, who will be asked to modify their lifestyle by quitting smoking, drinking no alcohol or moderate amounts, eating a healthy diet and exercising regularly.

“You may not have to take a pill,” said Dr. Jamerson. “These discussions are more work for a provider, but it’s great for the patient. They’re brought into the process.”

If medicine is needed, the new directions are to treat earlier and more aggressively to get blood pressure into the normal range right off the bat. “Our data shows controlling early works,” Dr. Jamerson said.

That’s different from the old-school way of prescribing one drug and slowly upping the dose or adding other meds if the patient doesn’t reach the target.

The guidelines also offer race-specific treatment recommendations by addressing drug efficacy in African-Americans. The guidelines point out that thiazide-type diuretics and/or calcium channel blockers are more effective in lowering blood pressure in African-Americans when given alone or at the beginning of multidrug regimens.

Dr. Jamerson said there is no downside to more aggressively treating high blood pressure from the start. “If one takes the long view, then everyone should appreciate this approach,” he said. “The cost of medications to treat more people is small when compared to the cost of a stroke, cardiovascular disease or heart failure. It’s a no-brainer.”