Dr. Melvin Echols, a cardiologist and Associate Professor of Medicine at Morehouse School of Medicine, brings both professional expertise and personal insight to addressing critical heart health issues in the African American community. As the Chief Health Advancement Officer for the American College of Cardiology, Dr. Echols combines his medical knowledge with his background growing up in rural North Carolina to provide a unique perspective on cardiovascular disease prevention and treatment. His journey from witnessing heart disease in his own family to becoming a leading cardiologist has equipped him with a deep understanding of the challenges faced by Black Americans in maintaining heart health and accessing quality care.
What are the most common cardiovascular diseases affecting the African American community and why are we at higher risk?
One of the biggest factors, and this is one of the most modifiable risk factors that actually affects African American community here, is high blood pressure, hypertension. We do know that one out of 4 people across the globe and in the US will have hypertension, but what we don’t know is that one out of every 2 African Americans will have hypertension, and there’s a large percentage of people who actually don’t know that.
There’s the space where awareness is key in terms of knowing your numbers, knowing what a high blood pressure is, and knowing why it’s important to bring it down. Then there is also the space of which I feel the medical community has not helped with, but that’s the clinical inertia of treating blood pressure.
I’ve treated thousands of patients, and I’m very much aware of how it comes across when you have either a man or a woman who is doing their thing busy with work, taking care of family, and all of a sudden you’re telling them that they have to stop and take 2 blood pressure medicines that might make them run to the bathroom or have other things go on, but you’ve got to be able to talk through those things, you’ve got to be able to make sure that they understand. Look, if something happens to me, can I talk about it? And will you help me?
What are some warning signs of heart disease that people often overlook?
When you talk about acute signs and symptoms, let’s take it to the actual emergent issues of a heart attack, or what we consider acute heart failure event, or a stroke, or an abnormal rhythm problem. Those 4 things are the main things that drive people to the emergency room in the middle of the night whenever they don’t really understand what’s going on.
If you’ve never had a history of asthma or anything like that, and all of a sudden you’re sitting up in the middle of the night because you can’t breathe, because if you lay down, that’s not your normal. So instead of doing that for 2 or 3 months, and then finally, until you can’t take it anymore, the EMS is coming to pull you out of your house. Understand like what’s really going on here? What can I do about it?
I think African American people have just been so traumatized in America for so long for medical things, whether that’s access, whether that’s judgment, whether that’s implicit biases. It has stunned people for, I think, knowing how to ask and what to ask, and even feeling comfortable asking questions. You, as a patient, have the right to know about your body, and so if whoever is treating you doesn’t feel like it’s worth taking time to talk about that to you, I think you have some decisions to make.
What are the best lifestyle changes we can make to lower our risk of heart disease?
The evidence will say, right now, the best diet that seems to be beneficial for heart disease is a plant based diet with low saturated fats. What I will say is that even though that may be the case, there are millions of people in America that have grown up eating particular ways because of culture and because of unity, and a lot of times, that’s what has brought people together.
I think it’s about moderation and understanding that as you change your behavior, you make small changes, and over time, as you gradually kind of build up the bigger changes, this ultimately makes a bigger impact.
Everything can be reduced when you sit down and you eat. I grew up in a rural place where poverty was, my mom raised us off of $10,000 a year, 3 boys and her, and so, you did not want to waste meals. That mentality of cleaning your plate and not wasting food, that sort of scarcity is still in a lot of people today. We have to understand that there are a lot of implicit things within ourselves that we do, and we don’t even know why we do them, but we just have to take time and just make small changes over time.
What’s the connection between physical activity and heart health?
Move, move, move! That’s what we know. AHA will say 150 min of exercise over the course of the week. It doesn’t necessarily have to be in big 30 min chunks. It can be 10 min, plus whatever throughout the day, but move.
My granddad passed at 98, and was chopping wood the winter before he passed, because he was always moving. We don’t live as long these days, primarily because of our sedentary lifestyles, and so even steps. If you’re in a sedentary job and you’re not getting steps, increasing your steps a couple 1,000, just if you’re only getting 2,000 a day just starting there. Small changes make huge differences.
Do what you feel, and just keep doing it. I think we need to encourage and empower more people to associate those things, and the way you feel.
How important is sleep for heart health?
It actually can be a very bad thing if you don’t get enough. The AHA American Heart Association has what was once Life’s Simple 7, which were a measure of 7 different things that if you actually monitored or changed, increased the likelihood that you would reduce your risk of heart problems. The last one that was just recently added a couple of years ago is Life’s Simple 8, now is sleep.
We know, for people who don’t get enough sleep, it actually increases your risk for problems, heart disease, heart mortality, and then also other things like arrhythmia or heart abnormality problems. So you definitely want to try your best to have good sleep.
It’s about the sleep hygiene, you have to look through your day. Are you taking naps during the day? Are you drinking alcohol right before you go to bed? Are you having a heavy meal? Are there things that are causing your sleep to be disrupted that you need to work on? Really, it’s about being very in tune to your body.
How can Black families incorporate heart health discussions in their daily lives?
I definitely think it can happen, and I definitely think it’s possible. My granddad developed diabetes later in life. My aunts and uncles, they realize, “Oh, wait! It’s because of the way we’ve been eating all this long time.”
I remember them having a conversation with my grandmother, who actually initially felt a little bit hurt about it. Because when you’re telling someone who has lived their life trying to make people happy on the little means that they can, they want to make sure that people are satisfied. She slowly understood that less salt and less lard and those things actually could make a difference, and my granddad was on insulin at one point, lost weight, lost about 20 pounds, got off of insulin at like 80 something years old.
It doesn’t have to always be about fear. It can be about seeing the change and seeing how it happens. I know for a lot of families that the mother is the helm of health changes. It shouldn’t be that way. Everything should not be on Black women for their families, but I will say that they have great influence and great impact, and so getting stakeholders like the moms and the family actually definitely can do some great things.
What is a single message you would like to share about taking control of heart health?
You don’t know what you don’t know, so if you do not know what your blood pressure is, if you do not know what your blood sugar is, if you do not know what your cholesterol is, go get it checked. Know your numbers, know what they mean, because then you can be empowered to change them.
Do not be afraid of preventive care. Preventive care can stop a lot of those major heart problems that we see. I wish we had better access to preventive measures.
Please seek good sources of information. In this era with technology, misinformation, and disinformation in many of the vulnerable communities is one of the primary targets, for disaster and disparities and everything else. In your community, vet the source of information that is coming to you and understand how to find quality information if something sounds a little wonky.
What are some trusted resources for heart health information?
The American College of Cardiology, as well as the American Heart Association, are two of the main heart associations here. Those two are really guarded by evidence. We put out guidelines in different conditions that help people follow the evidence. If things are going to be done right and done in an optimal way, that is where people get the evidence from.
