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African-Americans More at Risk for Heart Disease

Posted February 15, 2021 by Grace Ayafor, M.D., FSCAI

Elderly African-American couple preparing a healthy meal

February is Black History Month, when we recognize African-Americans and those of color who have played major roles in shaping our present culture. February is also American Heart Health month – a time to raise awareness of heart disease. While these two events are different, they are linked in healthcare. Heart disease remains the number one killer of Americans, and African-Americans are 20 percent more likely to die from heart disease than non-Hispanic whites.

We do not fully understand all the reasons why a person’s race or ethnic background affects their heart health. We do know that African-Americans have high rates of risk factors for heart disease, such as high blood pressure, obesity, diabetes and lack of exercise. These are all problems that can be helped with lifestyle changes. There may be biological differences that add to these risk factors. For example, some studies suggest that Blacks have lower levels of renin in their blood (a protein that regulates blood pressure) and are more sensitive to salt. Their artery walls may also be more likely to start stiffening at an earlier age than whites. All of these problems may lead to high blood pressure (known as hypertension), a cause of heart disease. In spite of potential biological differences, it is clear that a healthier diet and regular physical activity improve these risk factors.

Also, the question of personal choice and culture often comes up. There is a lot of evidence that where people live, work and learn can affect their heart health later in life. For example, poorer children and those exposed to violence early in life can develop problems with their blood vessels, inflammation, and their “fight or flight” response to stress. These problems may cause them to develop high blood pressure and other risks for heart disease earlier in life. 

Racism and bias within the healthcare system may also lead to poor medical care and outcomes. If doctors and nurses are racially biased, they may not talk as much to Black patients or pay as much attention to them. Patients treated this way may not believe their doctors and ignore the medical advice they are given. False beliefs, such as Blacks having a higher pain tolerance than whites (reported in a study of medical students and residents as recently as 2016), obviously lead to poor treatment. 

Summa Health is actively involved in reducing health differences in communities of color. The Summa Health Equity Center provides community-based culturally competent care, health educational programs and support groups, and even licensed social workers that help deal with some of the social, financial and psychological issues affecting access to healthcare. Summa is also actively involved in research on implicit bias through Project Implicit. It is led by Dr. Yoleetah Ilodi, who is also Assistant Dean of Diversity at NEOMED. Summa Health employees also get regular training on diversity and inclusion, as well as chances to hear others’ opinions (like this blog). 

In addition to Summa’s system-wide efforts to stop racial differences in healthcare, I encourage us as individuals to work on understanding our own biases, to commit to interact respectfully with every individual we come across and continue to provide exceptional care whatever a patient’s race and ethnicity. We should even consider going the extra mile for people at higher risk of poorer outcomes. As the current pandemic has shown us, failure to protect at-risk communities can have terrible effects on the overall health of our nation. 

Grace N Ayafor, MD

Grace N Ayafor, MD

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