February 22, 2023 – It was week 17 of every week that ought to have been completely normal. Monday Night Football Showdown between the Buffalo Bills and the Cincinnati Bengals. But Bills safety Damar Hamlin's tackle on Bengals receiver Tee Higgins could have ultimately been the deciding think about the sport – not just for football, but in addition for the inequalities in heart disease within the USA.
Hamlin, 24, the sudden cardiac arrest after being struck within the chest by Higgins' right shoulder in the primary quarter of the Jan. 2 game, he was on the bottom for about 19 minutes while first responders performed cardiopulmonary resuscitation (CPR) and used an automatic external defibrillator (AED) to restart his heart. The incident – which has drawn attention to a rare condition (an emotion of the center) and the importance of public motion – is also a turning point for a community that has long been within the highlight for poor heart health: Black Americans.
“Although we have made tremendous progress in reducing the burden of heart attacks and strokes, we need to take a different approach to get everyone's attention,” says Clyde Yancy, MD, chief of cardiology and vice dean for diversity and inclusion at Northwestern Medicine in Chicago and past president of the American Heart Association.
“A typical example is the episode with Damar Hamlin. Everyone in the country is now aware of the benefits of CPR,” he says. “We have not always been able to seize a moment to capture public attention so quickly and sustainably.”
This is particularly true for a lot of Black Americans, who take community support for health and wellness without any consideration.
“This is the beginning of a change that can happen on a broad front,” says Yancy.
Persistent inequalities, social ties
Black adults proceed to have the best rates of hypertension (hypertension) and associated complications in younger years, according to the American Heart Association.
Increased incidence of heart failure, strokes and narrowed blood vessels that reduce blood flow to the limbs (peripheral arterial occlusive disease) also disproportionately affect black Americans, although Total prices of coronary heart disease don't differ significantly from those of white colleagues.
Over and beyond, current findings The ongoing multiethnic study on atherosclerosis (hardening of the arteries) shows that blacks have the best death rate from all causes in comparison with whites, Chinese and Hispanics and, after adjusting for age and gender, even have a 72 percent higher risk of dying from heart disease in comparison with whites.
“After we accounted for the social determinants of health, the differences in mortality between blacks and whites almost completely disappeared,” explains Wendy Post, MD, professor of cardiology at Johns Hopkins Medicine in Baltimore and lead creator of the study. “This means that we would probably have similar mortality rates if we had the same environmental conditions.”
By “environment,” Post means the influence of non-medical aspects on health, higher referred to as social determinants of health. Research is increasingly specializing in how these aspects are likely to perpetuate health disparities and poorer cardiovascular outcomes amongst black Americans.
“We are beginning to understand that this significant increase in cardiovascular disease is due to significant disparities in the social determinants of health. This can include everything from access to routine health care, to insurance coverage, to medications, to food supply and access to healthy foods,” says Dr. Roquell Wyche, a Washington, DC-based cardiologist.
Wyche explains that social determinants of health may also include “housing, access to a healthy environment that allows for physical activity, where a person can feel safe in their environment, socioeconomic status, job and employment security, and transportation. All of these factors have significant impacts on cardiovascular health, and African Americans experience greater social disadvantages across all of these determinants.”
Currently, the World Health Organization estimates that Social determinants of health account for as much as 55% of overall health status.
Quentin Youmans, MD, cardiologist at Northwestern Medicine Bluhm Cardiovascular Institute in ChicagoWyche agrees and points to the hypertension rates within the black population for example.
“When we think about the leading cause of poor health and cardiovascular disease, we think of hypertension as a leading cause in black Americans. And it's not just the prevalence of hypertension; we know that in black patients, even when they have a diagnosis, their blood pressure is less likely to be controlled,” he says.
“The [hypertension] is a very insidious disease” that usually goes undiagnosed and will not cause symptoms until the patient goes to the doctor with heart problems or a stroke. “And because of these factors that contribute to patients not having access to medical care, they may suffer from high blood pressure for longer.”
Importantly, access to care includes access to proven treatments. A study supported by the National Institutes of Health published last month In Circulation: Heart failure showed that black patients treated in specialty heart failure centers were about half as prone to receive evidence-based, life-changing therapies (equivalent to transplants or mechanical blood pumps called ventricular assist devices, or VADs) as white adults.
But when researchers took into consideration aspects that affect health, including disease severity and social determinants of health equivalent to education, income and insurance, the differences remained even when patients expressed the identical preference for life-saving treatments. In their discussion, the study authors also identified that unconscious bias and structural racism also contribute to how these health determinants play out in lots of conditions.
“We need to look at how structural racism really impacts African Americans, especially with regard to the social determinants of health,” notes Wyche, who also serves as director of leadership development for the American Heart Association’s Greater Washington board of directors.
That's to not say genetics don't play a job, though. A family history of heart disease, equivalent to type 2 diabetes, also has a direct impact on health. For example, poor access to healthy foods or lack of monetary means to purchase medication can worsen diabetes or, more importantly, limit the power to reverse prediabetes (the stage before diabetes) through lifestyle changes. Currently, the American Heart Association estimates that black American men are 1.5 times more prone to develop diabetes than white men, and black women are 2.4 times more likely than white women.
A way forward
Structural racism and even unconscious bias play a key role in perpetuating poor heart health amongst African Americans. Yancy emphasizes that the prevalence of heart disease represents each a risk and a chance.
“We know strategies that work; we have evidence that shows we can change the burden of disease and improve outcomes,” he says. “So the greatest risk and the greatest need really is among those who identify as African American or Black. But that's also where the greatest opportunity is if we implement the things that we know to be true based on solid evidence.”
Yancy explains that in 2010 he supported the American Heart Association's efforts to advertise change by creating Life's Simple 7 (updated in 2022 to The essence of life 8), a guide to achieving higher heart health by changing certain behaviors and key indicators of heart problems: food plan, sleep, physical activity, smoking cessation, weight control, cholesterol, blood sugar, and blood pressure.
“Primordial prevention, i.e. risk prevention itself, is a key aspect,” he says. “This allows us to get to the bottom of the actual cause of high blood pressure and diabetes – much of which is related to dietary choices and physical activity in early childhood.”
Now, he says, “we just need to have the will to make changes at the community level.”
One strategy, in response to Wyche, is to hunt medical assist in early maturity in an effort to develop a sort of prevention strategy before a disease develops and to seek out out whether risk aspects equivalent to hypertension or high cholesterol are already resulting in serious illness.
“While routine annual screening is important, we are also finding that African-American women in particular are beginning to show signs of cardiovascular disease in their twenties.”
Another strategy is to acknowledge that social determinants of health and related health outcomes are common across generations and families and to see this as a chance.
“The most important thing that comes to mind is not just to involve the patient, but to recognize that sometimes the risk can be intergenerational,” says Youmans. “If we can shift our focus [from] By focusing on the individual patient and thinking about generations and entire families, we may be able to encourage more people to follow the recommendations needed for ideal or optimal health.”
Yancy, Youmans, Post and Wyche remain optimistic despite the inequities in health care access and outcomes — and the increasing public attention to their connection to oppressive structures and policies — which have been dropped at the forefront by each COVID-related disruptions and Black Lives Matter.
“I believe we have been through a generational movement,” Yancy says. “I think that in 10 years we will see the positive results of the transformative experiences of the last 3 years, with a more diverse workforce, a workforce more aware of the burden of disease on community members, community members recognizing the diseases of their own communities, and leaders seeking change in public policy.”