Black Americans Still at Higher Risk for Heart Trouble

By Amy Norton
HealthDay Reporter

Black Americans have been persistently hard-hit with heart disease risk factors for the past 20 years and social issues like unemployment and low income account for a good deal of it, a new study finds.

Cardiovascular disease, which includes heart disease and stroke, is the No.1 killer of Americans, and it's well-known that it exacts a disproportionate toll on Black Americans.

The new study published Oct. 5 in the Journal of the American Medical Association focused on risk factors for heart and blood vessel disease, such as high blood pressure, diabetes and obesity. And Black Americans carried a heavier burden of those conditions than white, Asian and Hispanic folks, the study authors said.

But the findings also highlight a key reason why.

"A lot of the difference may be explained by social determinants of health," said lead researcher Dr. Jiang He, of Tulane University School of Public Health and Tropical Medicine, in New Orleans.

That term refers to the wider context of people's lives and its impact on their health: A healthy diet and exercise might do a heart good, for instance, but it's easier said than done if you have to work two jobs to pay the rent.

In their study, He and his colleagues were able to account for some of those social determinants: people's educational attainment, income, whether they owned a home, and whether they had health insurance and a regular health care provider.

It turned out those factors went a long way in explaining why Black Americans faced particularly high heart disease risks. The study is not the first to trace the nation's health disparities to social factors, including structural racism - the ways in which society is set up to give advantages to one race over others.

Dr. Keith Churchwell was the lead author of a recent statement from the American Heart Association (AHA) on the subject. In it, the AHA said structural racism needs to be recognized as a "fundamental cause of persistent health disparities in the United States."

Churchwell said the new findings are in line with past evidence, the kind that drove the AHA statement. Racial disparities in health start with things as fundamental as educational opportunities, nutrition, stable housing and transportation, according to Churchwell, who is also president of Yale New Haven Hospital in Connecticut.

"I think we're all coming to the realization that if we're going to improve the health of our communities, these social determinants have to be addressed," said Churchwell, who was not involved in the new study. "They have a bigger impact than the medications we give and the procedures we do."

For the study, He's team used data from a long-running federal health survey. The investigators found that between 1999 and 2018, Americans saw an increase in certain risk factors for heart disease and stroke. The prevalence of obesity soared from 30% to 42%, while the rate of diabetes rose from 8% to almost 13%.

Meanwhile, average blood pressure levels held fairly steady, while blood sugar levels rose. The picture differed by race and ethnicity, however, and Black Americans were consistently worse off than white, Asian and Hispanic Americans.

And by 2018, Black adults had, on average, an 8% chance of developing heart disease or stroke in the next 10 years (based on their risk factors). That compared with a roughly 6% chance among white Americans, the investigators found.

Then He's team weighed the social factors that they could. And those issues appeared to explain a large amount of the difference between Black and white Americans' cardiovascular risks.

Still, He said, the survey did not capture other, more nuanced factors. For example, can people afford healthy food? Do they have safe places for exercise?

Even asking people about "access" to health care fails to tell the whole story, He noted: The quality of that care including whether providers and patients are communicating well with each other is critical.

"If we want to improve population health," He said, "we need to pay attention to these social determinants."

According to Churchwell, health care systems can help tackle broader issues in various ways, including partnering with community organizations and evaluating themselves with the help of electronic medical records to ensure they are providing equitable care.

It is not enough to simply tell patients to eat better and exercise, Churchwell said.

From the patient side, he encouraged people to ask about resources in their community, for help with anything from exercise to mental health support.

"Say to your provider, 'Help me figure this out,'" Churchwell said.

Researchers Explore How COVID-19 Affects Heart Health in Black Women

 By American Heart Association News (8/25/20)

Nearly six months into the COVID-19 pandemic, two things have become clear: The virus profoundly impacts people with heart disease and disproportionately impacts Black people. But the many manifestations of these disparities remains unclear, particularly for one group regularly left out of medical research.

"African American women are often at the intersection of the worst economic and health disparities," said Dr. Michelle Albert, a cardiologist and professor of medicine at the University of California, San Francisco. "They are a group that is often overlooked."

In a collaborative investigation with the Slone Epidemiology Center at Boston University, Albert is leading a study to look at a cohort of women enrolled in the Black Women's Health Study to determine the myriad ways in which COVID-19 is impacting them.

She said she chose to study this demographic because Black women often are at higher risk for heart disease than women in other demographic groups, and they are shouldering an excessive burden during the pandemic.

African Americans with COVID-19 are nearly three times as likely to require hospitalization than white people with the disease, according to a recent study published in the journal Health Affairs. According to statistics compiled by the nonprofit American Public Media Research Lab, Black and Indigenous people die from COVID-19 at more than three to four times the rate of white people.

Cardiovascular disease, research shows, could play a substantial role in those deaths. And for African American women especially, the risks for heart disease are high. Four out of 5 Black women are considered overweight or have obesity – the highest rate of any group in the country, according to the U.S. Office of Minority Health, and they are 60% more likely to have high blood pressure than their white counterparts.

Those risks didn't happen in a vacuum, experts say. Numerous factors place greater stress on African American women that can affect their health.

"The United States has a longstanding history of disparities in education, income, wealth and housing, and these factors, or social determinants of health, disproportionately affect African Americans – and African American women in particular," said Yvonne Commodore-Mensah, assistant professor at Johns Hopkins School of Nursing and the School of Public Health in Baltimore. She also is a faculty member at Johns Hopkins' Center for Health Equity.

"These social determinants of health result in a burden of underlying risk factors for COVID-19: high blood pressure, diabetes, overweight and obesity. These risk factors increase the risk for severe COVID-19 illness and mortality."

African American women may also be more exposed to contagion, said Dr. LaPrincess Brewer, assistant professor of medicine in the Mayo Clinic's department of cardiovascular medicine in Rochester, Minnesota. "They are more likely to hold service sector jobs that increase their risk of exposure to COVID-19. They are more likely to serve as heads of household."

What's more, Albert said, "they are caregivers of multiple generations, including children and elderly relatives and extended family. And they are more likely to experience every kind of bias – medical as well as racial/ethnic biases – in housing and employment."

All of these factors multiply stress, which can impact heart health. "This pandemic has really affected the livelihood of the African American community and the ability of community members to maintain a healthy lifestyle," said Brewer. "It's largely related to the extreme burden of stressors resulting from this crisis."

But as evidence begins to emerge showing COVID-19 has a widespread, adverse impact on cardiovascular health, the data is not being collected in ways that allow researchers to look at its impact on specific demographic groups – information that could be critical in helping to identify treatments and prevention strategies for those at highest risk.

Albert's study was among a dozen recently funded by the American Heart Association to investigate heart and brain issues related to COVID-19. The AHA also created a COVID-19 CVD Registry that is working to enroll historically underrepresented groups. The registry is collecting data from thousands of COVID-19 patients nationwide to advance the work of scientists, doctors and researchers investigating the coronavirus.

Albert said she hopes her research findings pinpoint the experiences and perceptions of African American women so that targeted solutions can be developed. The research community needs to do more studies like this, those in the field say.

"When we collect data, we have to report it systematically, so we can analyze it to understand what complications may affect African American women differently than white women," Commodore-Mensah said. "Without this data, we have an incomplete picture of what affects the risk for severe COVID-19 illness and death.

"Women in general are not well represented in research studies on cardiovascular health," she said. "Compounding that, Black women are less represented than white women, for different reasons."

They may be unable to get off work to take part in clinical trial visits, she said. Or those recruiting patients may lack cultural sensitivity. Further compounding the issue is a deep-seated distrust of the medical research community, which has a long history in the United States of unethical treatment, abuse and exploitation of African American patients.

Commodore-Mensah said those challenges could be overcome by doing a better job of communicating the benefit of research studies and making sure trusted individuals, such as faith and community leaders, are the ones delivering those messages.

"We also need to make sure the research team reflects the population we are studying," she said.

Blacks and Heart Valve Disease

African Americans have the highest rate of heart valve disease in the U.S. The danger of heart valve disease is that it's condition is too often undiagnosed and untreated. Blacks are less likely to undergo surgery to repair heart valves due to not being evaluated for surgery, declining to pursue surgical repair, or being unaware of it.  

According to a study commissioned by the Alliance for Aging Research, the public at large has an insufficient awareness of heart valve disease, but this is acutely true for minority populations. The nationwide survey conducted for the study, only 18 percent of African-Americans were familiar with heart valve disease. This is a particularly dangerous finding, given the high propensity of Black Americans to be afflicted with cardiovascular illnesses and congestive heart failure.

What is Heart Valve Disease?

Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary.

The mitral and tricuspid valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body.

The mitral and aortic valves are the ones most frequently affected by valvular heart disease. Normally functioning valves ensure that blood flows with proper force in the proper direction at the proper time. In valvular heart disease, the valves become too narrow and hardened (stenotic) to open fully, or are unable to close completely (incompetent).

A stenotic (narrowed, tight) valve forces blood to back up in the adjacent heart chamber, while an incompetent (leaky) valve allows blood to leak back into the chamber it previously exited. To compensate for poor pumping action, the heart muscle enlarges and thickens, thereby losing elasticity and efficiency. In addition, in some cases, blood pooling in the chambers of the heart has a greater tendency to clot, increasing the risk of stroke or pulmonary embolism.

The severity of valvular heart disease varies. In mild cases, there may be no symptoms, while in advanced cases, valvular heart disease may lead to congestive heart failure and other complications. Treatment depends upon the extent of the disease.

What Symptoms Will I Get if I Have Heart Valve Disease?

Heart valve disease symptoms can occur suddenly, depending upon how quickly the disease develops. If it advances slowly, then your heart may adjust and you may not notice the onset of any symptoms easily. 

Additionally, the severity of the symptoms does not necessarily correlate to the severity of the valve disease. That is, you could have no symptoms at all, but have severe valve disease. Conversely, severe symptoms could arise from even a small valve leak.

Many of the symptoms are similar to those associated with congestive heart failure, such as shortness of breath and wheezing after limited physical exertion and swelling of the feet, ankles, hands or abdomen (oedema). Other symptoms include:

*Palpitations, chest pain (may be mild).

*Fatigue.

*Dizziness or fainting (with aortic stenosis).

*Fever (with bacterial endocarditis, infection over a damaged valve).

*Rapid weight gain due to fluid accumulation

What Causes my Heart Valve to be Damaged or Diseased?

There are many different types of valve disease; some types can be present at birth (congenital), while others may be acquired later in life; the following are causes for damaged heart valves:

*Heart valve tissue may degenerate with age.

*Rheumatic fever may cause valvular heart disease.

*Bacterial endocarditis; an infection of the inner lining of the heart muscle and heart valves (endocardium), is a cause of valvular heart disease.

*High blood pressure and atherosclerosis may damage the aortic valve.

*A heart attack may damage the muscles that control the heart valves.

*Other disorders such as carcinoid tumors, rheumatoid arthritis, systemic lupus erythematosus, or syphilis may damage one or more heart valves.

*Methysergide, a medication used to treat migraine headaches, and some diet drugs may promote valvular heart disease.

*Radiation therapy (used to treat cancer) may be associated with valvular heart disease.

Is There Anything I Can do to Prevent Heart Valve Disease?

Get prompt treatment for a sore throat that lasts longer than 48 hours, especially if accompanied by a fever. Timely administration of antibiotics may prevent the development of rheumatic fever which can cause valvular heart disease.

A heart-healthy lifestyle is also advised to reduce the risks of high blood pressure, atherosclerosis and heart attack. Don’t smoke and consume no more than 5 alcoholic beverages per week.

Eat a healthy, balanced diet low in salt and fat, exercise regularly and lose weight if you are overweight. Adhere to a prescribed treatment program for other forms of heart disease. If you are diabetic, maintain careful control of your blood sugar.

How is Heart Valve Disease Diagnosed?

As part of your heart valve disease diagnosis you will undergo one or more of the following tests:

*An electrocardiogram, also called an ECG or EKG, to measure the electrical activity of the heart, regularity of heartbeats, thickening of the heart muscle (hypertrophy) and heart-muscle damage from coronary artery disease.

*Stress testing, also known as treadmill tests, measure blood pressure, heart rate, ECG changes and breathing rates during exercise. During this test, the heart’s electrical activity is monitored through small metal sensors applied to your skin while you exercise on a treadmill.

*Chest X-rays

*Echocardiogram to evaluate heart function. During this test, sound waves bounced off the heart are recorded and translated into images. The pictures can reveal abnormal heart size, shape and movement. Echocardiography also can be used to calculate the ejection fraction, or volume of blood pumped out to the body when the heart contracts.

*Cardiac catheterization, which is the threading of a catheter into the heart chambers to measure pressure irregularities across the valves (to detect stenosis) or to observe backflow of an injected dye on an X-ray (to detect incompetence).

What Treatment is Available for Heart Valve Disease?

The following provides an overview of the treatment options for valvular heart disease:

*Don’t smoke; follow prevention tips for a heart-healthy lifestyle. Avoid excessive alcohol consumption, excessive salt intake and diet pills—all of which may raise blood pressure.

*If you are not very limited by the valve disease and if the valve on assessment does not appear severely diseased, I might suggest a “watch and wait” policy particularly with mild or asymptomatic cases.

*A course of antibiotics is prescribed prior to surgery or dental work for those with valvular heart disease, to prevent bacterial endocarditis.

*Long-term antibiotic therapy is recommended to prevent a recurrence of streptococcal infection in those who have had rheumatic fever.

*Antithrombotic (clot-preventing) medications such as aspirin and or clopidogrel may be prescribed for those with valvular heart disease who have experienced unexplained transient ischemic attacks, also known as TIAs (mini-stroke).

*More potent anticoagulants, such as warfarin, may be prescribed for those who have atrial fibrillation (a common complication of mitral valve disease) or who continue to experience TIAs despite initial treatment. Long-term administration of anticoagulants may be necessary following valve replacement surgery because prosthetic valves are associated with a higher risk of blood clots.

*Balloon dilatation (a surgical technique involving insertion into a blood vessel of a small balloon that is led via catheter to the narrowed site and then inflated) may be done to widen a stenotic valve.

*Valve surgery to repair or replace a damaged valve may be necessary.

*Replacement valves may be artificial (prosthetic valves) or made from animal tissue (bioprosthetic valves). The type of replacement valve selected depends on your age, condition and the specific valve affected.

Is There Any Alternative to Open Heart Surgery?

A number of per-cutaneous minimally-invasive (key hole) cardiac interventions are becoming increasingly popular and can give as good results as the open surgery which include:

*TAVR (Trans-catheter Aortic Valve Replacement)- to treat a tightly narrowed aortic valve (Aortic Stenosis)

*MITRACLIP procedure to treat a leaky Mitral Valve

*Baloon Valvotomy to expand tight (stenotic) mitral or aortic valves

Black people Get Fewer Heart Valve Replacements, But Inequity Gap is Narrowing

 By American Heart Association News (8/11/20)

Black people with severely malfunctioning heart valves are less likely than their white peers to receive lifesaving valve replacements, according to a new study.

The study, published Tuesday in the Journal of the American Heart Association, looked at the treatment rates by race for aortic valve stenosis, a condition when the valve doesn't open and close properly and may leak blood.

Recent valve replacement technology has increased the life expectancy for people with the worst cases. If left untreated, half of patients with severe aortic valve stenosis die within two years, the study said. With treatment, however, they can get relief from symptoms and return to "a normal life trajectory."

Researchers examined a decade of electronic health records for 32,853 people with severe aortic valve stenosis and found valve replacement rates were low regardless of race: Only 36% of patients got the procedure within a year of their diagnosis.

"The big elephant in the room is that two-thirds of patients who ought to be treated are not getting treated. It's still a major problem," said the study's lead author, Dr. J. Matthew Brennan.

Even after adjusting for socioeconomic factors, researchers found Black people with the condition were less likely to undergo valve replacement than white people – 22.9% versus 31% – despite similar one-year survival rates for both races.

The racial gap narrowed slightly – 29.5% versus 35.2%, respectively – during 2015-2016 because more Black people received transcatheter aortic valve replacements. Also called TAVR, it is a newer, minimally invasive procedure whose use has dramatically increased in recent years for patients with severe stenosis. With TAVR, doctors insert an artificial valve into the diseased valve using a less invasive procedure, with potentially less complications and a quicker recovery.

Despite the progress in closing the gap on racial disparities, obstacles remain for Black people with aortic valve stenosis, according to the study.

"I think we're only seeing the tip of this iceberg," said Brennan, an interventional cardiologist at Duke University Medical Center. "We only looked at patients who'd been diagnosed and there are a lot of folks who don't get medical care, especially in minority populations."

Brennan said he'd like to see future studies explore why racial differences in treatment persist and how doctors can detect the disease quicker.

"People need to understand this is a deadly disease, treatment is critical, and if people are treated, they really do well," he said.

Dr. Mohamad Adnan Alkhouli, who was not involved in the research, said past studies had found racial differences in aortic valve replacement rates but didn't look specifically at people with confirmed cases of severe stenosis.

"This study is very important because for the first time it documents a clear racial disparity among those who are already diagnosed. It gets to the bottom of the disparity so we can start to fix it," said Alkhouli, a cardiologist and professor at Mayo Clinic School of Medicine in Rochester, Minnesota.

He called for heart and medical organizations "to get together and come up with a final plan for action," and for future studies to address why the disparities exist.

"The big question where is the gap? Is it in access to care, provision of care, or both? Do socioeconomic and cultural differences also play a role?It's a big puzzle, but each new study will add a bit of knowledge to solve the puzzle."

Blacks, Heart Disease, and the COVID-19 Virus Pandemic

by Kenny Anderson

Recent reports from all over the U.S. shows Blacks are disproportionately dying from the COVID-19 pandemic due to pre-existing chronic diseases.

In a new study published for the Center of Disease Control (CDC) Morbidity and Mortality Weekly Report, researchers found that the majority of those hospitalized due to COVID-19 have preexisting conditions about 90% of patients.

One of these underlying conditions is heart disease, recent data from the American Heart Association shows that 48% of Black women 20 and older have heart disease, while 44% of Black men 20 and older have heart disease.

Black women have a 31% death rate from heart disease while Black men have a 34% death rate. A recent study revealed that before age 50 Blacks heart rate failure rate is 20 times higher than that of whites. 

The COVID-19 virus could possibly infect the heart muscle directly. 

According to Scientific America, recent studies cites that patients who had heart disease before their coronavirus infections were much more likely to show heart damage afterward. 

For example in March, doctors from China published two studies that gave the first glimpse at how prevalent cardiac problems were among patients with COVID-19 illness.

The larger of the two studies looked at 416 hospitalized patients. The researchers found that 19% showed signs of heart damage. And those who did were significantly more likely to die: 51% of those with heart damage died versus 4.5% who did not have it.

Patients who had heart disease before their coronavirus infections were much more likely to show heart damage afterward. However some patients with no previous heart disease also showed signs of cardiac damage.

Patients with no preexisting heart conditions who incurred heart damage during their infection were more likely to die than patients with previous heart disease but no COVID-19-induced cardiac damage.

Many cardiac specialists believe a COVID-19 infection leads to damage to the heart in several ways. Some other cardiologists believe the heart damage observed in COVID-19 patients could be from the virus directly infecting the heart muscle.

Initial research suggests the coronavirus attaches to certain receptors in the lungs and those same receptors are found in heart muscle as well; thus the virus affects the heart directly. This could change the way doctors and hospitals need to think about patients, particularly in the early stages of illness.

It also could open up a second front in the battle against the COVID-19 pandemic, with a need for new precautions in people with preexisting heart problems, new demands for equipment and, ultimately, new treatment plans for damaged hearts among those who survive.

Heart Disease Risk Profiles Differ Widely Among African-Americans, Blacks From the Caribbean and Africa

- AMERICAN HEART ASSOCIATION

African immigrants have significantly lower rates of risk factors for heart attacks, strokes and other cardiovascular diseases compared to blacks from the Caribbean and African Americans. According to preliminary research presented at the American Heart Association's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2020. 

The EPI Scientific Sessions is a premier global exchange of the latest advances in population based cardiovascular science for researchers and clinicians.

Black Americans experience more heart attacks, strokes and other cardiovascular diseases compared to white Americans, which is likely due to higher prevalence of risk factors, such as high blood pressure, obesity, diabetes and others. 

However, this might not be true for black Americans who have more diverse ethnic backgrounds or who have emigrated from Africa or the Caribbean.

Cardiovascular disease kills more than 100,000 U.S. Black Americans each year. 

"Prior research into heart disease racial disparities typically has studied only African Americans or has grouped U.S. and foreign-born blacks without considering ethnicity, birthplace or other factors," said lead study author Diana Baptiste, D.N.P., R.N., C.N.E., assistant professor at The Johns Hopkins University School of Nursing in Baltimore, Maryland.

Researchers studied 82,000 non-Hispanic blacks and 370,000 whites who took part from 2010 through 2018 in the National Health Interview Survey, a nationally representative, in-person survey conducted yearly in Spanish and English. 

The researchers found differences among the three different ethnic classifications for black Americans and compared them to whites for all four heart disease risk factors studied: high blood pressure, diabetes, excess weight and smoking.

"The study shows that race alone doesn't account for risk factor differences between blacks and whites," said Baptiste. "Among all the groups, African immigrants, who have the highest degree of African ancestry, had the lowest burden of risk factors."

Using statistics from 2018, the study found the prevalence of:

*High blood pressure was 17% for African immigrants; 32% for Afro-Caribbeans; 42% for African Americans and 34% for whites;

*Smoking was 5% for African immigrants; 8% for Afro-Caribbeans; 18% for African Americans and 16% for whites.

*Diabetes was 9% for African immigrants; 19% for Afro-Caribbeans; 15% for African Americans and 10% for whites; and

*Overweight/obesity was 60% for African immigrants; 68% for Afro-Caribbeans; 76% for African Americans and 66% for whites.

The study also accounted for socioeconomic factors and found that African immigrants were the most likely to be college educated, yet the least likely to have health insurance:

40% of African immigrants had a college education, compared to 26% of Afro-Caribbeans, 21% of African Americans and 36% of white Americans. However, only 76% of African immigrants had health insurance, compared to 81%, 83% and 91% of Afro-Caribbeans, African Americans and white Americans respectively.

The findings suggest that environmental, psychological, and social differences could help account for differences in cardiovascular risk factors. "We were quite surprised by the stark differences in socioeconomic factors among the black ethnic groups," Baptiste said.

Baptiste and her colleagues have been advocating that subgroups of U.S. blacks be defined separately in medical research. "Cultural and genetic influences, along with social factors such as wealth and employment, marital status, how people are educated and where they live and work, can affect risk and how it is managed, and ultimately health outcomes," she said.

The number of black immigrants in the U.S. has roughly doubled in the past 40 years, according to the Pew Research Center. "Much of the diversification of the black population has occurred in and around major metropolitan cities. We need to account for these shifts in our research and care for our patients, and in our training of health care professionals," Baptiste said.

"Our results suggest that although racial disparities in heart disease risk factors exist, ethnic disparities among blacks need to be addressed to ensure that health care delivery and public health strategies are properly tailored to these populations," Baptiste said.

"The strength of the study was the amount of data available for a large group of people. However, only 5% of the study group were African immigrants and only 8% were Afro-Caribbeans, so it is not possible to extrapolate these findings to the U.S. population of black Americans or people of African ancestry in general.

For example, African immigrants in this study tended to be younger and better educated, which correlates with better heart health. That doesn't mean it would be true for the hundreds of millions of people living in Africa or in the Caribbean, " said Ivor Benjamin, M.D., FAHA, immediate past-president of the American Heart Association and director of the Cardiovascular Center at the Medical College of Wisconsin in Milwaukee.

"The findings from this study are intriguing, but African Americans still make up the vast majority of black Americans in the U.S., and we need to do a better job of making sure all Americans have access to health insurance, healthier food and safe places to be physically active," said Benjamin.

Cardiovascular disease kills more than 100,000 U.S. black Americans each year. An estimated 90% of heart attacks, strokes or other cardiovascular events in blacks are due to elevated or borderline cardiovascular disease risk factors, including high blood pressure, diabetes, excess weight/obesity and smoking, compared with a rate of about 65% in whites.

*Editorial Note: It's not surprising that there are differences between African-Americans higher and specifically Africans lower rates of heart disease. Based on my own logic and research I've done, enslaved Black women were pregnant under extreme racist trauma and anxiety that caused 'over-stress' to their fetuses causing continual 'fetal elevated heart rates'. Moreover from my perspective the internal stress of pregnant Black mothers 'epigenetically warped' the heart cells in their fetuses that would have lasting DNA damage resulting in a generational high vulnerability 'risk factor' to heart disease - Kenny Anderson

Black History & Heart Awareness Month and Black Maternal Deaths

by Kenny Anderson

A major medical group the American College of Obstetricians and Gynecologists (ACOG) has issued new guidance on detecting and treating the leading cause of death in pregnant women and new mothers in the United States.

In the U.S. Black women are 3 to 4 times more likely to die of pregnancy related causes than white women regardless of education and socioeconomic status. 

According to the Center of Disease Control Black mothers die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health.

To put maternal deaths in perspective a Black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy or childbirth related causes. 

The maternal mortality crisis is rooted in racism; the marginalization of Black women and the institutional barriers to quality health care. For most Black women this means being exposed to multiple forms of discrimination disparities.

Thus Black maternal health outcomes are largely tied to social determinants including health and systems services, location, employment, education, race, and income.

Black women are more likely to:

*Be uninsured before becoming pregnant

*Be poorer and experience more hardships

*Be more distressed and anxious

*Be exposed to environmental risks

*Receive subpar medical care based on their location

*Experience racial bias from health care providers 

Heart Disease and Black Maternal Deaths

Heart disease accounts for 26.5% of pregnancy-related deaths, and rates are highest among Black women and those with low incomes. The risk of death from heart disease is 3.4 times higher among Black women than white women.

A heart muscle disease called peripartum cardiomyopathy is the leading cause of death in expectant mothers, accounting for 23% of deaths late in pregnancy. 

Cardiomyopathy, along with thrombotic pulmonary embolism, and hypertensive disorders of pregnancy contributed more to pregnancy-related deaths among Black women than among white women.

During pregnancy the cardiovascular system undergoes major changes to sustain tremendous increases in blood volume. Dr. James Martin, chairman of ACOG's pregnancy and heart disease task force says "pregnancy is a natural stress test."

While pre-existing conditions play a part in the death toll, acquired heart conditions can develop silently during or after pregnancy. Common risk factors for maternal death due to heart disease include age, high blood pressure during pregnancy, and obesity.

Curbing Black Maternal Deaths

The American College of Obstetricians and Gynecologists (ACOG) has set new guidelines on screening, diagnosis and management of heart disease.

ACOG President Dr. Lisa Hollier said: "Most maternal deaths are preventable, but we are missing opportunities to identify risk factors prior to pregnancy and there are often delays in recognizing symptoms during pregnancy and postpartum, particularly for Black women."

The American College of Obstetricians and Gynecologists recommends:

*Women with known heart disease should see a cardiologist before getting pregnant and receive pre-pregnancy counseling, the practice guidelines advise.

*A follow-up visit with a primary care doctor or cardiologist should occur within 10 days for women with high blood pressure disorders and within seven to 14 days for women with heart disease and related disorders.

*Patients with moderate and high-risk heart disease should be managed during pregnancy, delivery, and postpartum in a medical center that can provide a higher level of care.

*Collaboration between health care providers particularly ob-gyns and cardiologists is crucial.

*Develop a long-term comprehensive care plan; a cardiovascular postpartum visit at the three-month mark, at which time the clinician and patient can discuss collaborative plans for yearly follow-up and future pregnancy intentions. The increased risk of death from heart disease can last up to a year after a woman gives birth. 

Community Intervention

Curbing maternal mortality requires investment specifically in Black maternal health care and solutions that engage inequities undermining health outcomes for Black mothers and their babies.

From my perspective to reduce the high rates of maternal deaths of Black women begins at the community level by exposing, educating, advocating, promoting, and investing in community led prevention strategies.