Dr. Elizabeth O. Ofili talks race and heart health

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There is no question that African Americans have been — and continue to be — greatly impacted by cardiovascular diseases.

In the United States, 1 in every 4 deaths annually are caused by heart disease.But December’s passing of celebrated singer Natalie Cole gripped the headlines and shone a national spotlight on one particular condition — heart failure.

Heart failure is the only major cardiovascular disorder on the rise.3 A misnomer, heart failure does not mean the heart has suddenly stopped working — it is instead a condition that develops over time and means the heart cannot pump enough blood to meet the body’s needs.3 Symptoms can include shortness of breath during normal day-to-day activities, weight gain with swelling in the feet, legs, ankles, or stomach, and difficulty breathing when lying down.4

Nearly six million Americans are living with this progressive illness,5 but African-Americans in particular are disproportionately impacted.6 They are 20 times more likely than whites to develop heart failure before the age of 50 7 and have higher death rates too.6 When African Americans are hospitalized for heart failure, they have a 45 percent greater risk of death or decline in functional status than whites.6

Despite these clear-cut statistics, the problem is undoubtedly complex. During this dual awareness month, it’s important to examine the underlying factors and barriers often working in tandem and increasing the disproportionate impact of heart failure on the black community.6

Understanding Potential Physiological Differences

In recent years, care and treatment have become increasingly individualized, as providers are looking more closely at the unique health profile of each patient, known as personalized medicine. Our evolving understanding of heart failure in African Americans should be no exception.

Key research has suggested that physiological differences or specific genetic factors may play a role in heart failure.6 The bottom-left chamber of African Americans’ hearts has more instances of abnormalities and enlargement than those of white patients.6 The small arteries of our hearts are also less elastic, which may be related to a decreased level of nitric oxide naturally found in the body.6

Since these differences may ultimately play a role in a patient’s physical well-being, it’s vital that we acknowledge their potential impact when examining heart health.

Tallying the Risks for African Americans

Regardless of race or ethnicity, heart failure does not manifest itself overnight3 — several risk factors can contribute.8 A person’s chance of developing heart failure can increase if they suffer from other health issues such as diabetes, high blood pressure, and obesity,8 all of which are prevalent conditions in African Americans.9 For example, about 2 in 5 African American men have high blood pressure.10 Sixty-three percent of men and 77 percent of women are overweight or obese, among non-Hispanic blacks age 20 and older.11 And the list goes on.

Oftentimes, these risk factors are then compounded upon and amplified by common, but harmful lifestyle habits.8 African Americans are not the only racial group where there are instances of high fat and cholesterol intake, a lack of exercise and tobacco use, all of which are lifestyle factors than can contribute to and aggravate heart failure.8 But when combined with the potential physiological and genetic differences and other risk factors, those lifestyle habits can further exacerbate the prevalence and impact of heart failure.8

When Impact and Disparities are Intertwined

Beyond these factors, a continued area of concern for African Americans with heart failure is ongoing healthcare disparities. Most are familiar with the long and painful history of African Americans not receiving optimal health care. But even now, despite so many medical breakthroughs, many of these challenges are yet to be resolved. In 2015, results from an Emory University study showed that overall blacks were less trusting than whites that their physician cared about them as a person.12 Study responses also showed that blacks were less likely to trust a doctor’s interpersonal competence.12

These barriers can also limit the availability of effective treatment options specifically for African-Americans. Although heart disease is responsible for nearly 24 percent of deaths in non-Hispanic Blacks,2 African Americans account for less than 20 percent of subjects in cardiovascular trials.13 The African American Heart Failure Trial (A-HeFT) studied heart failure therapy in 1050 self-identified African-American patients.14

It’s a start. But as our approach to care and treatment becomes more individualized and we move away from the “one size fits all” model, the medical community, patients and caregivers must continue to push towards equal understanding and prioritization of care for a condition that affects so many African Americans.

Take the first step in not only raising your awareness but also the awareness of others. When providers, patients, and caregivers are aligned on the unique factors driving a condition like heart failure in African Americans, we become a community, opening the door for more honest, actionable dialogue. To be successful in heart failure, we must first be our own empowered health advocate not yet another barrier.

Dr. Ofili is a paid spokesperson of Arbor Pharmaceuticals, LLC.

Elizabeth O. Ofili, M.D., M.P.H., FACC, is a practicing cardiologist as well as a professor of medicine and senior associate dean for clinical and translational research at Morehouse School of Medicine. Dr. Ofili is an elected member of the National Academy of Medicine and the Institute of Medicine, the recipient of over 50 scientific, service and health policy awards and has published over 150 scientific papers and book chapters. In 2002, as president of the Association of Black Cardiologists, she led the initiative to implement the landmark African American Heart Failure Trial (A-HeFT), whose findings led to a change in practice guidelines for the treatment of heart failure in African-Americans. A nationally and internationally recognized clinician scientist, she currently serves on several boards, including the NIH Clinical Center Advisory Board and the Cardiovascular Examination Committee of the American Board of Internal Medicine.

2Heart Disease Facts. Centers for Disease Control and Prevention website. http://www.cdc.gov/heartdisease/facts.htm. Updated August 10, 2015. Accessed January 13, 2016.

3Quick Heart Failure Facts. Heart Failure Society of America website. http://www.hfsa.org/about-hfsa/quick-heart-failure-facts/. Accessed January 13, 2016.

4Heart Failure Fact Sheet. Centers for Disease Control and Prevention website. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm. Updated November 30, 2015. Accessed January 14, 2016.

5Understand Your Risk for Heart Failure. American Heart Association website. http://www.heart.org/HEARTORG/Conditions/HeartFailure/CausesAndRisksForHeartFailure/Understand-Your-Risk-for-Heart-Failure_UCM_477645_Article.jsp#.Vpf7_vkrLIU. Updated September 29, 2015. Accessed January 13, 2016.

6Sharma A, Colvin-Adams M, Yancy CW. Heart failure in African Americans: disparities can be overcome. Cleve Clin J Med. 2014;81(5):301-311.

7Bibbins-Domingo K, Pletcher MJ, Lin F, et al. Racial differences in incident heart failure among young adults. N Engl J Med. 2009;360:1179-1190.

8Causes of Heart Failure. American Heart Association website. http://www.heart.org/HEARTORG/Conditions/HeartFailure/CausesAndRisksForHeartFailure/Causes-of-Heart-Failure_UCM_477643_Article.jsp#.Vpj-q_krLIV. Updated October 22, 2015. Accessed January 13, 2016.

9High Blood Pressure and African Americans. American Heart Association website. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/High-Blood-Pressure-and-African-Americans_UCM_301832_Article.jsp#.Vpj-7_krLIV. Updated August 13, 2014. Accessed January 13, 2016.

10High Blood Pressure Facts. Centers for Disease Control and Prevention website. http://www.cdc.gov/bloodpressure/facts.htm. Updated February 19, 2015. Accessed January 15, 2016.

11African-Americans and Heart Disease, Stroke. American Heart Association website. http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/African-Americans-and-Heart-Disease-Stroke_UCM_444863_Article.jsp#.VpkXfPkrLIU. Updated September 16, 2015. Accessed January 13, 2016.

12Sewell AA. Disaggregating ethnoracial disparities in physician trust. Social Science Research. 2015;54:1–20. doi:10.1016/j.ssresearch.2015.06.020.

13 Mitchell JE, Ferdinand KC, Watson KE, et al. Treatment of heart failure in African Americans—a call to action. J Natl Med Assoc. 2011;103(2):86-98.

14Taylor AL, Ziesche S, Yancy C, et al. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med. 2004;351(20):2049-2057.

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