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HEART Insight:
doi: 10.1097/01.HEARTI.0000422221.42687.ce
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Does Race and Ethnicity Play a Role in Heart Disease?

Gordon, Sandra

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Abstract

Unfortunately, differences in medical care exist for racial and ethnic minorities with heart conditions

Every 25 seconds, someone has a coronary event in the United States. Every 39 seconds, someone has a heart attack. And every 40 seconds, someone has a stroke. We're all at increased risk for heart attack and stroke as we get older. Still, cardiovascular disease is far from an equal-opportunity offender. Based on statistics, it seems to target certain racial and ethnic groups, contributing to a lower life expectancy. Consider these facts:

* Hypertension, which increases the risk of stroke, affects 41 percent of African-Americans, more than any other racial group in the world. Hypertension develops earlier in life in African-Americans than Caucasians and is also likely to be more severe.

* More than 25 million American adults have diabetes, which increases the risk of heart attack and stroke, but Asians, people of Hispanic/Latino descent and African-Americans bear more of the burden of the disease. The prevalence in African-Americans age 75 and over is expected to rise more than any other group—a whopping 606 percent—by 2050.

* High cholesterol, a major risk factor for stroke and heart attack, affects more Caucasian women and Mexican-American men and women.

“Genetics may contribute to a higher risk for hypertension, but cultural barriers, social factors, lack of access to healthcare, lack of understanding and poor communication are far more important than the genetic contributions to cardiovascular disease,” says Lori Mosca, M.D., M.P.H., Ph.D., director of the New York-Presbyterian Hospital Preventive Cardiology Program, chair of the guidelines writing committee and a medical advisor for the American Heart Association's Go Red for Women movement. The upshot? Your DNA isn't your destiny. Most of the factors contributing to the increased risk and rate of cardiovascular disease are within our control, regardless of our race or ethnicity.

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KNOWLEDGE IS POWER

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Reducing the risk and rate of cardiovascular disease across the board starts with something as simple as knowing that it's a major health threat. “Step one is getting the awareness level up,” Mosca says, “which is linked to taking preventive action.” When people aren't aware there's a high risk, they don't get to the doctor for a check-up or to the emergency department if they're having symptoms.

Among women in the United States, knowledge related to heart disease risk has been improving over the past 10 years. But some racial and ethnic groups lag behind. A 2012 study in the Journal of Women's Health, for example, which analyzed American Heart Association (AHA) national surveys from 2006 and 2009, found that African-American and Hispanic women were 66 percent less likely than Caucasian women to be aware that heart disease is a leading cause of death in women. “African-American and Hispanic women are where Caucasian women were 10 years ago,” Mosca says, which is contradictory, given their higher rates of coronary heart disease, diabetes and hypertension.

The AHA is dedicated to closing the knowledge gap through their public health campaigns, such as Go Red Por Tu Corazon (GoRedCorazon.org), the sister movement of Go Red for Women. This bilingual heart-health movement for Latinas promotes a heart-healthy lifestyle through healthy eating and physical activity, building on Latinas' strong ties to family and cultural traditions. Likewise, the Power to End Stroke (powertoendstroke.org), an education and awareness campaign designed for the African-American community, “has recruited hundreds of thousands of individuals and made them more aware of the definition of stroke, the risk of stroke and what's necessary if you believe you're having a stroke or an impending stroke,” says Clyde W. Yancy, M.D., MSc, chief of the Division of Cardiology at Northwestern University's Feinberg School of Medicine in Chicago.

Still, we could all use a review. According to a recent survey, among people in 14 states and Washington, D.C., only 27 percent were aware of the five heart attack warning signs and symptoms and knew to call 9-1-1 first if they thought someone was having a heart attack or stroke. (See Stroke warning signs and Warning signs of a heart attack for more information.) Feel free to cut out these important reminders and post them in a place where you'll see them often so you'll know what to watch for and what to do in an emergency.

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PARTNER WITH YOUR DOCTOR FOR PREVENTION

Beyond awareness, the next step to reducing the rate and risk of cardiovascular disease is to bridge any communication gap between patients and healthcare providers. With medical care, ideally, everybody receives the same treatment when exhibiting the same symptoms. But it's a complex system. Unfortunately, differences in medical care exist for racial and ethnic minorities with heart conditions. A review by the Kaiser Family Foundation, which analyzed the racial and ethnic differences in cardiac care from 1984 to 2001, found that African-Americans, Hispanics and Asians were less likely than Caucasians to receive appropriate diagnostic procedures and care when presenting with heart disease.

To help level the playing field, the AHA supports quality improvement initiatives aimed at reducing healthcare disparity. It held its first Health Equity Summit in 2010 to focus on solutions to improving quality care across cultures. The Get With The Guidelines program also helps ensure the most recent American Heart Association/American Stroke Association scientific guidelines for patient treatment are consistently applied in hospitals and outpatient practices across the country.

Meanwhile, patients can help themselves by partnering with their healthcare provider. “The truth is, anyone can end up on the wrong end of a disparate care cycle,” says Yancy. “Getting quality medical care starts with communicating with your provider.” Here are some ways to make sure you get quality medical care for yourself or a loved one, regardless of your race or ethnic background, age or gender.

* Find a doctor with whom you identify. If you'd prefer to work with a doctor of the same race but can't find one, try to find providers who are culturally sensitive to your issues. “You might be able to pick that up just by talking with them,” Mosca says.

* Do your homework about treatment options. “If you believe you're not receiving the care you believe another person might be getting for the same condition, simply speak up and say, ‘What about this other care?’” Yancy says. Research your condition on the Internet on sites such as heart.org and bring printouts to your appointments.

* Prod and nudge. To enhance your understanding about your condition, test results and treatment options, ask your doctor questions, such as: “This isn't clear to me. Can you explain further?” Or “If I have questions later, who should I call?” “Be clear in your questions and expect clarity in the delivery of the information,” Yancy says. For more ways to become a proactive patient, visit heartinsight.com to read our online-only bonus article, “Make the Most of Your Next Doctor's Visit.”

The bottom line? No matter what your race or ethnic background, “with chronic conditions like heart disease, stroke and high blood pressure, your physician can only do so much for you,” says Salvador Cruz-Flores, M.D., professor of neurology at St. Louis University. “A lot depends on what you can do for yourself, such as taking your medication on schedule, stopping smoking, eating a heart-healthy diet, exercising three to four times per week and losing weight if you need to.”

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Stroke warning signs

A stroke is a medical emergency. During a stroke, brain cells starved of oxygen die and don't regenerate. Time lost is brain lost and can increase the chances of a poor outcome.

If you or someone near you experiences any of the signs below, immediately call 9-1-1 or the emergency medical services number so an ambulance (ideally with advanced life support) can be sent for you.

Also, check the time so you'll know when the first symptoms appeared. It's very important to take immediate action. If given within 3 hours of the start of symptoms, a clot-busting drug called tissue plasminogen activator may reduce long-term disability for the most common type of stroke.

* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

* Sudden confusion, trouble speaking or understanding

* Sudden trouble seeing in one or both eyes

* Sudden trouble walking, dizziness, loss of balance or coordination

* Sudden severe headache with no known cause

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Warning signs of a heart attack

If you or someone you know experiences these signs or symptoms, call 9-1-1 first so help can be on its way.

* Chest pain: uncomfortable pressure or pain that lasts for more than a few minutes or goes away and comes back

* Pain in the jaw, neck or back

* Shortness of breath: the feeling that you can't catch your breath

* Sweating: when suffering the chest pain of a heart attack, it's common to break out in a cold sweat

* Feeling weak, light headed or faint

© 2012 American Heart Association, Inc.

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