In the bright, sterile halls of Piedmont Atlanta Hospital in Buckhead, cardiac nurse practitioner Cindy Milligan has witnessed a recurring scene that has become all too familiar. Patients arrive in critical condition, their blood pressure readings climbing to dangerous heights, their kidneys failing and their bodies on the brink of stroke or heart attack. When asked about their last doctor’s visit, they cannot answer. This pattern of delayed care has become what Milligan calls “the constant” in her years working with the advanced heart failure transplant team, particularly among African American patients.
“We’re finding out all these things at one time, and it’s a little too late,” Milligan explains with a measured calm that belies the urgency of her message. “The blood pressure has been high, their kidneys are in renal failure, or they’re coming in with a stroke or heart attack.”
This delayed care phenomenon represents just one facet of a complex problem facing Black Americans, a problem rooted in historical mistrust, generational patterns and misunderstanding of chronic disease management. Speaking with remarkable candor, Milligan offers insights into the challenges and potential solutions for improving heart health outcomes in the African American community.
The shadow of mistrust looms large
When asked about the root causes, Milligan does not hesitate to acknowledge the role of historical trauma and systemic issues. “It definitely has some stigma with it,” she reflects, drawing on personal experience. “I can remember my grandparents, they didn’t like going to the doctor, my dad hated going to the doctor.”
This aversion to seeking medical care stems from a deep-seated mistrust of healthcare providers, particularly those who don’t share the same racial background as their patients. “They are nervous, they’re afraid,” Milligan explains. “It’s that mistrust of providers, especially when they don’t look like us.”
The historical context cannot be ignored. Decades of documented medical abuses against Black Americans have created a legacy of suspicion that continues to influence healthcare decisions today. “It stems back from things that have happened in the past,” Milligan notes, referencing a widespread perception “that they’re trying to harm us as a community.”
In the age of information, this mistrust manifests in new ways. “Google now is everyone’s friend,” Milligan observes. Patients often research medications independently, encountering frightening lists of potential side effects that may discourage them from following prescribed treatment plans. “They read one side effect, they take the pill once, and they think they’re having that side effect.”
The trifecta of risk
Central to Milligan’s message is what she calls “the trifecta” of heart disease risk factors, three conditions that disproportionately affect African Americans and dramatically increase the likelihood of severe cardiac events. These three conditions form the foundation of cardiovascular risk:
First, high blood pressure, often called the silent killer because it typically presents with no symptoms until significant damage has occurred. African Americans develop high blood pressure at higher rates and at earlier ages than other demographic groups.
Second, diabetes, a condition that affects the body’s ability to process sugar and can damage blood vessels over time. Black Americans are 60 percent more likely to be diagnosed with diabetes than non-Hispanic whites.
Third, high cholesterol, which contributes to the narrowing and hardening of arteries, restricting blood flow to vital organs including the heart and brain.
“That’s the trifecta that is going to lead to heart disease. It’s going to lead to stroke,” Milligan warns. The risk is exponentially higher for those with a family history of these conditions. “If you have a family history of those things, your risk factors are just through the roof.”
The medication misconception
One of the most dangerous patterns Milligan identifies is patients’ tendency to stop taking prescribed medications once symptoms improve. “If their blood pressure gets better, they’re like, ‘Well, I’m cured. I don’t need to take it,'” she explains. This misunderstanding of how chronic disease medications work leads to a dangerous cycle of improvement followed by serious decline.
“That’s the whole reason that you’re on it, so your blood pressure can improve,” Milligan clarifies. “You have to keep taking it so it’s not going to elevate again and keep causing those long-term issues.”
For male patients, an additional barrier often goes undiscussed. Many blood pressure medications can affect sexual function, leading men to discontinue their treatment without consulting their doctors. “That is one of the number one reasons that a lot of men stop taking their blood pressure medicine,” Milligan reveals, noting that these patients often return with dangerously elevated blood pressure readings and serious complications.
With characteristic frankness, Milligan addresses this issue directly with her patients. “I have very candid conversations with my patients, just so they know that there’s other things that we can give them so they don’t have that side effect.” This approach exemplifies her commitment to finding solutions that patients can maintain long-term.
A path forward for heart health
For younger generations concerned about their heart health, particularly those with family histories of cardiovascular disease, Milligan offers clear, actionable advice. Regular check-ups with comprehensive lab work form the foundation of prevention. “Getting your yearly physical, making sure your labs are done checking your kidney function, your cholesterol levels,” she advises.
Beyond medical monitoring, lifestyle modifications play a crucial role. “Eating healthy, exercising and just moving,” Milligan recommends. “It doesn’t have to be strenuous exercise. Walking three to four times a week, twenty minutes a day.”
The modern sedentary lifestyle represents a significant risk factor in itself. “We have a very sedentary lifestyle now,” Milligan observes. “We don’t go out and walk, and we’re not outside anymore like we used to be.”
Dietary changes can also make a substantial difference in managing blood pressure and cholesterol. Milligan specifically mentions reducing sodium intake and moving away from fried foods. “Shaking that extra salt after your food is cooked, it has a big effect,” she notes. Transitioning to baked foods instead of fried ones can “direct blood pressure and cholesterol levels tremendously.”
Most importantly, Milligan emphasizes that heart disease can affect people of any age. “There’s no age limit to where these things can affect people,” she cautions. “There’s people in their twenties with high blood pressure, there’s people in their twenties and thirties with high cholesterol and diabetes.”
As our conversation draws to a close, the core of Milligan’s message becomes clear. The path to improved heart health in the African American community requires addressing both medical and cultural factors, combining better education about chronic disease management with healthcare delivery that acknowledges historical context and builds trust.
For Milligan, education represents the most powerful tool in this effort. “I love to do that with my patients and the families, just explaining these disease processes,” she says. By helping patients understand how conditions develop and how treatments work, she hopes to overcome the barriers that have kept too many from receiving timely care.
In the ongoing battle against heart disease, Milligan stands as both healer and advocate, treating not just the physical manifestations of cardiovascular illness but also working to mend the broken trust that has contributed to its disproportionate impact on the Black community. Her work reminds us that addressing health disparities requires more than medical interventions alone, it demands honest conversation, cultural understanding and a commitment to building relationships that can withstand the weight of history.
