More CVD and Stroke Drive Shorter Life Spans in African-Americans: AHA

African-Americans have a higher prevalence of cardiovascular risk factors, including earlier onset of hypertension, obesity, and diabetes, and these marked disparities are largely responsible for their shorter life expectancy when compared with white individuals, according to a new scientific statement from the American Heart Association (AHA).

“At present, African-Americans make up 13.3% of the US population and are the second-largest racial/ethnic minority behind Hispanic/Latinos,” the document notes, but their life expectancy is, on average, 3.4 years shorter than that of white individuals.

“The primary cause of that disparity is higher rates of mortality from cardiovascular diseases,” Mercedes Carnethon, PhD (Northwestern University Feinberg School of Medicine, Chicago, IL), chair of the new AHA scientific statement, told TCTMD. “We’ve seen significant advances in reducing rates of cardiovascular disease development over time and improvements in the survival rate in the overall population, but those benefits haven’t really been achieved by all groups, particularly African-Americans.”

In order to make progress toward the AHA’s stated goal of improving the cardiovascular health of all Americans by 20% and reducing deaths from cardiovascular diseases and stroke by 20%, the so-called 2020 Impact Goals, more targeted efforts are needed to address the cardiovascular health of African-Americans, say experts.  

Higher Burden of Risk Factors

In the new statement, which was published October 23, 2017, in Circulation, the AHA experts highlight the burden of cardiovascular disease and stroke, noting that death from coronary heart disease, heart failure, sudden cardiac arrest, cerebrovascular disease/stroke, and peripheral artery disease is higher among African-Americans than in white individuals.

The higher burden of cardiovascular risk factors, along with the earlier onset of these risk factors, is the primary driver of higher rates of disease, say experts. 

“African-Americans are developing risk factors for heart disease at younger ages and living with them longer,” said Carnethon. “For example, an African-American may have had hypertension for an extremely long period of time, causing a lot of damage to the vessels and leading to much higher rates of stroke.

In the last 60 years, death from stroke has declined by 80% across all ages, but there has been no meaningful decrease in the disparity between African-American and white individuals with respect to stroke mortality. Stroke mortality remains more than four times greater among nonwhite individuals, predominantly African-Americans, than among white persons, according to the AHA. 

Obesity is also more prevalent in African-Americans, which in turn contributes to high blood pressure, diabetes, lipid disorders, and chronic kidney disease, notes Carnethon. Among African-American men and women, 38% and 58% are considered obese, respectively, compared with 34% and 33% of white men and women. The management of cardiovascular risk factors is further complicated in obese individuals, she added.

Social Determinants of Health   

To TCTMD, Carnethon said preventive cardiovascular care has not always been available to African-American communities, nor has it been a priority, particularly in younger men. When younger men and women are not engaged in the healthcare system for preventive care, cardiovascular conditions and/or risk factors go untreated, which can lead to target organ damage.

“The best strategy is to highlight the preservation of ideal cardiovascular health in young adults, before it starts to decline,” she said. This involves setting healthy habits early in life, particularly in children and adolescents. The AHA statement notes that 20% of African-American children aged 2 to 19 years are obese compared with 15% of white children.

Access to healthy foods, safe spaces for physical activity, and other social aspects of health are important for determining whether individuals are capable of adopting healthy lifestyles, however. More than one-quarter of African-Americans live in poverty, and their median family income is significantly lower compared with the US population as a whole.

“In communities with limited socioeconomic resources, the ability to make changes is hindered,” said Carnethon. “The economic resources devoted to buying and preparing healthy foods, spending time physically active, getting the recommended 7 to 9 hours of sleep a night—that can all be very difficult when somebody is working more than one job.”    

Multifaceted and multilevel public health initiatives are needed to address the disparities in the cardiovascular health of African-Americans, according to the AHA. Targeted promotion of cardiovascular disease prevention in communities where African-Americans congregate and socialize are needed, as well policy changes that address everything from smoking bans to taxes on unhealthy foods, such as sugar-sweetened beverages.

Another strategy, the AHA says, is to repair the trust and increase the engagement of African-Americans in the healthcare system. One way to do that is to diversify the workforce of physicians, nurses, and other healthcare professionals to improve the comfort level of African-American patients.