WHAT BLACK WOMEN NEED TO KNOW ABOUT HEART DISEASE
Richard Allen Williams, M.D.
Almost 400,000 women die of heart disease in the United States each year, and a large percentage of them are black females. In fact, diseases of the heart and circulation, which include heart attacks, stroke, heart failure, kidney disease, hypertension, and diabetes, are responsible for killing more black women than anything else in our society. That includes cancer, although women tend to be more afraid of developing cancer than of getting heart trouble.
African American women are especially affected by heart disease in a negative manner. They have a higher mortality or death rate than white women and black men under the age of 55 years. The mortality rate from coronary heart disease is 69% higher than for white women. In addition, the first heart attack occurs at an earlier age in black women and is more likely to be fatal than is the case in white women. And premenopausal women who have hypertension, which is more common in black women, have 10 times the heart attack risk of those without high blood pressure.
The purpose of this article is to put African American women on notice that they are at great risk of dying or being disabled by what we call cardiovascular disease, or CVD, and that they need to take some precautionary steps to avoid being affected by these problems. Over the past several years, we have developed a knowledge base of information which allows us not only to look back and see what has happened to so many black women who have been affected by these disorders, but also to look ahead and to project what will happen to our women if certain corrective and preventive actions are not taken. An organization which I founded 46 years ago, called the Association of Black Cardiologists, has collected a great deal of that information.
This is a very appropriate time to bring up this subject because February is Heart Month, and Black History Month, which also contains Valentine’s Day, which symbolizes concerns about the heart.
What we will do is to give you some very basic information about the heart and circulation as well as the disorders which can potentially affect you—and in fact, may already be doing so. In all cases, remember that this is being provided to alert you to the possibility of CVD dangers in yourself, and you should consult your doctor or health care provider for further information and possible needed action.
Understanding the Cardiovascular System
The cardiovascular system consists of a network of organs, including the heart and kidneys, which are connected by a vast conglomeration of blood vessels, mainly arteries, veins, and capillaries, through which blood flows in a closed system which never connects to the outside unless it is by means of trauma (injury) or deliberate surgery. The heart beats normally on a regular schedule, propelling the blood through the blood vessels to deliver oxygen and nutrients to all of the body’s tissues and organs and picking up wastes such as carbon dioxide which are produced by metabolism within the body. One of the organs that is serviced by the cardiovascular system is the heart itself. For example, if it does not receive the oxygen supply that it needs because a coronary (heart) artery is clogged and blood flow is decreased, the heart muscle, which is called the myocardium, may become damaged. When it becomes partially starved of oxygen, we say that myocardial ischemia exists. When it becomes completely deprived of oxygen, the heart muscle will die, and we say that myocardial infarction (a heart attack) has occurred. The same thing can happen to the brain, leading to a stroke, or the kidneys, causing renal insufficiency. If the heart and blood vessels become overloaded with fluid, heart failure or high blood pressure (hypertension) may result. Of course, this is an oversimplification of what actually happens, but the main idea is that the cardiovascular system is very delicately balanced and if its function is disturbed, disease can occur. This is what African American women are prone to, and now we will explore some of the reasons for this.
Risk Factors in African American Women
Black women have the highest rates of what are called risk factors for cardiovascular disease in the country, when they are compared to men and women of their own race as well as other races. When you have a risk factor, that means that you are unusually likely to develop CVD, as opposed to people who have none. In addition, the more risk factors you have, the greater are the chance that you will have an adverse event involving the cardiovascular system such as a heart attack or a stroke. It has been well documented that African American women have the highest rates of the following risk factors:
- Smoking: 26% of black women smoke
- High blood pressure: about one-third of black women have hypertension
- Obesity: two-thirds of black women are overweight or obese
- Physical inactivity: the majority of black women do not exercise regularly
In addition, diabetes, which causes so many heart attacks that it is now considered a cardiovascular disease and a CVD risk equivalent, is found in a very high percentage of African American women.
It is interesting that women have a built-in protection against CVD when they are young or premenstrual. The protective element is estrogen, a sex hormone which occurs naturally in the body but declines as the woman grows older. As a result of estrogen’s protective action, women have their heart attacks about ten years later than men. However, smoking and diabetes completely nullify the protective advantage conferred by estrogen, and women who smoke and /or have diabetes may have heart attacks equal to the rate seen in men, and at the same age as men. Obviously, therefore, it is foolish for black women to smoke, especially if they have diabetes or any other risk factor, because then the risk of a cardiovascular event is multiplied. It has also been documented that the cardioprotective effects of aspirin are nullified by smoking.
In addition to the risk factors named above, there are others such as high cholesterol levels. Cholesterol is a sticky substance which plugs up the arteries of the body when it gets out of control, and when this happens to the coronary arteries which supply blood and oxygen to the heart or brain, a heart attack or stroke can occur. Cholesterol is in many of the foods which we eat, and it is also manufactured by the body. It is known as a lipid or blood fat. Some of the foods that contain high amounts of cholesterol are red meat, eggs, butter, and whole milk. There are many others. Trans fats, which are fats processed in a manner that preserves food longer, is especially dangerous, and you should avoid margarine and any food that contains it. Potato chips, fast food hamburgers, and many other products have it. If it is on the label of any food that you are thinking about buying, you should not buy that product. In general, any fried food you eat will contain excessive amounts of cholesterol, and these should be avoided. You can’t tell if your cholesterol is high unless you get it checked by a blood test done by a doctor. Fortunately, there are very effective medicines available to lower your cholesterol if needed, and eating the right diet definitely helps.
High blood pressure is very common in African Americans. It has multiple causes, one of which is heredity. It tends to run in families, and almost every African American person either has it or has a relative who does. Eating too much salt is definitely linked with hypertension, and this is something that is characteristic of the black diet. Fast foods and fried foods contain a lot of salt, too. A diet called the DASH diet (Dietary Approaches to Stop Hypertension) showed particular benefit in black women and was based on the use of low-salt foods, fruits, nuts, whole grains, and vegetables.
Blood pressure is a measure of the force which the blood exerts on the arteries carrying it, and it is recorded in two components, called the systolic pressure, which is caused by the beating of the heart, and the diastolic pressure, which is caused by the squeezing effect of the arteries on the blood inside of them. Systolic is the upper figure and diastolic is the lower figure in the blood pressure recording. For example, 120/80 is considered normal. Your doctor knows how to interpret your particular blood pressure and can tell you if it is high, and he will advise you on what to do about it. Again, there are many very effective medicines he can give you if your blood pressure is out of control. If left undetected and uncontrolled, high blood pressure can lead to heart attacks, stroke, kidney failure, and blindness. More than 71,000 African Americans die each year from hypertension. It can also aggravate diabetes if it is present and make it more difficult to control.
Obesity is another risk that black women have to contend with. As stated above, the majority of them are overweight or obese, and there is definitely a connection with heart disease, stroke, hypertension, and diabetes. Obesity tends to be aggravated by poor dietary habits such as eating fattening foods with a high caloric content. Although there has been controversy over which of several popular diets (Atkins, Ornish, Mediterranean, Weight Watchers, etc.) is best for losing weight, in actual fact, no particular diet has an advantage over the other, according to a recently published medical study. All will cause weight loss—the big battle is staying on the diet and maintaining the loss. Your doctor can definitely help with this, but there is a lot that you can do on your own. You can avoid fast foods, check the fat and carbohydrate grams in the foods before you buy them, and concentrate on eating whole grains, nuts, low-fat or skim milk, fruits, vegetables, fish, skinless poultry, and poly-unsaturated fats and oils such as canola and olive oil. Again, avoid trans-fats, which are in preserved and processed foods including potato chips and margarine, and stay away from saturated fats which are heavily concentrated in red meat.
Regular physical exercise is a must to be used in conjunction with the diet. Any amount of exercise such as brisk walking will help, but the greatest benefit is seen when the exercise is performed at least three times a week in an aerobic fashion which is done for at least 20-30 minutes to the point of sweating.
When you go to the doctor, ask him to measure your waist. If it is more than 35 inches around (in circumference), you have a very high risk of suffering a cardiovascular event and dying from it within five years, so you must do everything you can to reduce that waist! (The critical waist circumference is 40 inches for men.)
Warning Signs for Black Women
Unfortunately, CVD often strikes without warning, and the first hint of it may be sudden death, a heart attack, or a stroke. However, there are some things that may tip you off that you are headed for big trouble. These are called symptoms and signs. For instance, pain in the chest is a classic symptom of an impending heart attack, and it means that your heart is literally crying out for help. It is called angina. Black women do not experience it as commonly as white women, for reasons that are not entirely clear. It may also occur in locations other than the chest such as the back, arm, and even the jaw. It may or may not be associated with activity. If it does occur, it may be misinterpreted as indigestion or an upset stomach. The best advice is, don’t take a chance—go to the nearest hospital right away to be checked to make sure you are not having a heart attack. This is crucial, because half of the people who have a heart attack die on the first occasion. You may not get a second chance if you are having a heart attack and don’t get immediate medical attention. So use 911—that’s what it’s there for. Better safe than sorry. Shortness of breath, a fast heart beat, excessive sweating, unexplained weakness and tiredness, nausea and dizziness may also occur.
High blood pressure may not cause any signs or symptoms warning you of its presence until something happens, such as a stroke or heart attack. For this reason, it is called the “silent killer”. You really do need to get that blood pressure checked by a doctor, and more than one time. When hypertension does cause symptoms, they may include headache, dizziness, rapid heart beat (palpitations), or blurred vision. But don’t wait until these symptoms occur, because by then, dangerous complications stemming from damage to major organs may already be in progress.
Stroke is caused when the blood supply to the brain is interrupted, and it can also be caused by blood clots in these arteries or whenever a brain artery is ruptured or bursts, causing cerebral hemorrhage, which commonly occurs in black people who have hypertension. Strokes generally occur suddenly, often without warning. Some of the warning signs may be sudden numbness or weakness of the limbs or face, especially on one side, sudden confusion, difficulty speaking or walking, difficulty focusing the eyes, and headache. If any of these things happen, you should get to the hospital right away, because brain damage progresses within minutes and is usually permanent and irreversible unless treated very quickly. Call 911 immediately. You don’t even have time to get dressed.
In this brief article, I have tried to provide some information that will give African American women some “heads-up” guidelines to the prevention, detection and management of cardiovascular disease, which is our greatest killer. It is not possible in this small space to give more than a comprehensive overview of the problems, but hopefully, you have gotten the most important message of all, which is to get yourself checked out by a doctor and to heed the advice given. Your life and health are literally on the line. Remember, only you can take the steps necessary to save yourself. Black women are the greatest asset that we have in the African American community, and we must make every effort to preserve them. It is my hope that this advice will really be taken to heart.
If you would like to read more on the subject of heart health for African Americans, please visit the website of the Association of Black Cardiologists (the ABC) at www.abcardio.org, where several excellent references may be accessed. You may also call this organization at 800-753-9222. Another excellent reference is a book called The Heart of the Matter, by Hilton Hudson, M.D., Karol Watson, M.D., and Richard Allen Williams, M.D., published by Hilton Publishing Co. You can go on-line to check it out.
Richard Allen Williams, M.D.
Clinical Professor of Medicine, UCLA
The Minority Health Institute, Inc. (MHI)
Founder, The Association of Black Cardiologists, Inc. (ABC)
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“Blacks in Medicine: Clinical, Demographic, and Socioeconomic Correlations”
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