Cardiovascular disease and mortality remain higher in African Americans

The average life expectancy for African Americans is 3.4 years shorter than that of whites—a difference largely due to higher rates of heart attacks, sudden cardiac arrest, heart failure and strokes among African Americans, according to a new scientific statement from the American Heart Association (AHA), published in Circulation.

“Despite advances in the identification of risk factors for cardiovascular disease (CVD) and the widespread use of evidence-based strategies to manage CVD, racial/ethnic disparities in CVD morbidity and mortality persist in the United States. Across nearly every metric, African Americans have poorer overall cardiovascular health than non-Hispanic whites, and CVD mortality is higher in African Americans than whites,” wrote the authors of the AHA statement.

The statement offered numerous examples of poorer cardiovascular health among African Americans:

• Coronary heart disease (CHD): Incidence of CHD has declined in African American men in recent years, yet only by half (−3.2%/y) that of the decline in white men (−6.5%/y). Incidence of CHD declined only slightly in African American women (−4.0%/y), while it declined −5.2%/y in white women.

• Sudden cardiac arrest: Rates of sudden cardiac arrest are higher in African Americans than in whites. From 2002 to 2012, the rate of sudden cardiac arrest was 175 per 100,000 in African American men compared with 84 per 100,000 in white men. African American men and women who experienced sudden cardiac arrest were more than 6 years younger on average than their white counterparts.

• Stroke: Although stroke mortality has fallen by 80% overall in the past 60 years, stroke mortality rates among non-whites (predominately African Americans) remain 4.5-fold higher than among whites.

• Diabetes: African American men are 1.52 times more likely to develop type 2 diabetes mellitus than white men, and African American women are 2.14 times more likely to develop it than white women.

• Obesity: Among adults age 20 and older, African American women had the highest rates of obesity (58%), followed by African American men (38%), white men (34%), and white women (33%).

• Hypertension: Since 1999, rates of hypertension among African Americans have remained about 10% to 12% higher than rates of non-Hispanic whites and Mexican Americans.

“Hypertension is arguably the most potent risk to the cardiovascular health of African Americans, as well as the greatest area of opportunity for the prevention of disease if effectively managed and prevented,” wrote the authors, led by writing group chair Mercedes Carnethon, PhD, associate professor of preventive medicine (epidemiology) at Northwestern University’s Feinberg School of Medicine, Chicago, IL.

For controlling hypertension, social and cultural factors may be just as important as medical and clinical reasons, the authors noted. So, targeted prevention strategies, such as race-specific treatment guidelines, may be warranted.

An overabundance of adverse social and environmental factors are also major contributors to CVD disparities. For one, approximately 26% of African Americans live in poverty compared with 15% of the overall population. Education levels are lower on average, which compromises health literacy.

“As a result, preventive health resources (healthy foods, safe spaces for physical activity, psychological stability resulting from occupational stability) are not as widely available to the majority of African Americans,” the AHA authors wrote. “Consequently, the challenge of improving health among African Americans requires a broader structural approach.”

Reducing the significant burden of CVD morbidity and mortality among African Americans “will require collaborations across multiple disciplines, both within and outside of the traditional umbrella of healthcare providers given the complex historical, social, and economic reasons why African Americans experience poorer cardiovascular health,” the authors concluded. “Efforts to carry out high-quality research studies should be supplemented by additional research on the dissemination and implementation of effective interventions to modify health behaviors and to mitigate CVD risks.”