Why Are Minorities at Greater Risk for Heart Disease?

African-American men and women have double the rate of fatal heart disease of their white counterparts of the same age, according to an alarming new study published in Journal of the American Medical Association (JAMA) this week. Even though deaths from heart attacks and heart disease have dropped since the 1970s, the decline has been steeper for whites than for blacks, “widening a longstanding disparity,” the researchers reported.

Another study in the same issue of JAMA reports that up to 80 percent of US Hispanic/Latino adults have one or more major risk factors for cardiovascular disease, the leading killer of Americans. As a result, “this relatively young ethnic group is at high risk for future CVD morbidity and mortality as it ages,” the researchers predict.

What’s behind this deadly divide in heart attack and stroke risk? I talked to Monika Safford, MD, professor of medicine at the University of Alabama at Birmingham, and lead author of the African-American heart disease study.

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The First Coronary Event More Likely
to Kill African-Americans

Despite major breakthroughs in treating heart disease, African-Americans continue to die at far higher rates during their first coronary event, says Dr. Safford. “Most people were dying before they reached the hospital. It’s a terrible tragedy, because there is so much that can be done if someone makes it to the hospital, including revascularization procedures,” which are used to reopen blocked blood vessels and restore flow to the heart, such as bypass surgery.

In the study, the major killer was sudden cardiac arrest (SCA), in which the heart abruptly stops beating, halting flow to vital organs. Without immediate treatment, such as a shock from a defibrillator to jumpstart the heart, SCA is usually fatal within minutes. SCA can occur during or after a heart attack and is most likely to strike people with heart disease.

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Lack of Progress in Saving African-American Lives

With earlier studies also reporting similar disparities, the researchers stated that, “There has been disappointingly little progress in lowering the excess risk of death at the first clinical presentation of acute [heart disease] among blacks.” Even though rates of heart disease were similar in black and white men, African-American men had more than twice the risk of suffering a fatal coronary event.

The study analyzed health data from more than 24,000 people ages 45 and older, whose health and death rates were tracked over a 4.2-year period. Forty-two percent of the study participants were African-American, and 58 percent were women. Black women had about double the rate of fatal coronary events, along with higher rates of heart disease and non-fatal events, compared to white women.

Dangerous Disparities in Care

The study also found that African-Americans received far fewer revascularization procedures, such as coronary artery bypass surgery or balloon angioplasty, in which a narrow balloon-tipped catheter is snaked through the arteries, then inflated to widen the blocked area, which is often treated with a stent (a scaffold-like device that props the obstructed vessel open).

The high cost of these procedures—about $60,000 for bypass surgery and $10,000 for stents—as well as access to care and inadequate insurance coverage may be contributing factors in why far fewer African-Americans receive these potentially lifesaving interventions. Although the study wasn’t designed to explore this question, says Dr. Safford, “our suspicion is very high that not seeking treatment plays a role in why black people die from heart disease at a much higher rate.”

Adds Dr. Safford, “White people with chest pain or other heart-related symptoms may be more likely to go to the doctor, who initiates treatment, such as angioplasty, so those patients don’t die if they have a heart attack.”

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Astronomical Rise in Risk Factors

In a study of more than 16,000 Hispanic/Latino people living in the US, 80 percent of men ages 18 to 74 had at least one risk factor for CVD, such as obesity, high blood pressure, high cholesterol, smoking or diabetes, as did 71 percent of women. The leading CVD threat in Hispanic men was high cholesterol, while obesity ranked as the leading heart hazard for women.

African-Americans are also disproportionately affected by obesity, compared to whites, greatly magnifying their danger of type 2 diabetes, which in turn more than triples the threat of heart attack. “It’s hard to overstate how enormous this problem is,” says Dr. Safford. “There’s a prediction that one in three kids born in Alabama will develop the disease during their lifetime.” Nationally, rates are expected to triple in coming decades.

High blood pressure is also more common in blacks than whites, but there’s been significant progress in combatting this dangerous CVD risk. In fact, some studies suggest that African-Americans actually receive more aggressive treatment to get hypertension under control than whites do. However, tobacco use, which has plummeted since the 1970s, remains higher in minorities.

“We’ve known about these disparities in heart disease death rates for a long time and it’s terrible to still be seeing them today,” adds Dr. Safford. “The silver lining is that we know what risk factors are and there are effective interventions. We’re done a terrific job with raising awareness of high blood pressure through public health campaigns and as a society, we need to get serious about putting more resources into black communities to tackle problems like smoking.”

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