Risk Factors for Cardiovascular Disease   Fast Facts   Cardiovascular Disease Among African Americans   Women with Heart Disease   Causal Factors of Coronary Heart Disease   Difference in Care for Minorities   Cost of Heart Disease   References Hypertension is a highly prevalent, life-threatening chronic condition.  When uncontrolled, it is a risk factor for Coronary Heart Disease and stroke. Hypertension in the United States is now estimated to affect 60 million persons.(1) The prevalence increases with age and is twice as high among African Americans as among whites.(1) An African American hypertensive is 2-3 times more likely than a white person with hypertension to have a stroke.(1)   Fast Facts: Average age of first heart attack: 65.8 men, 70.4 women.(2) Coronary Heart Disease is the single leading cause of death among males, killing 245,005 in 2001. This represents 51% of deaths from Coronary Heart Disease(2) Coronary Heart Disease is the single leading cause of death of American females, killing 248,184 in 2001.  This represents 49% of the deaths from Coronary Heart Disease.(2) Fifty percent of men and 64% of women who died suddenly of Coronary Heart Disease had no previous symptoms.(2) In 2002 in the United States, 74 percent of heart transplant patients were white and 77% were male.(2)   Hypertension is the chief factor in stroke, the cause of 150,000 deaths in the United States each year, and a major risk factor for the 1 million heart attacks that occur in the country annually, 500,000 of which result in death.  Hypertension also contributes substantially to kidney disease.(3) An African American is 17 times more likely to progress to end-stage renal disease. (1) Back to Top Cardiovascular Disease in African Americans African American males are disproportionately affected by hypertension; of the approximately 62 million Americans who have hypertension or who are being treated for hypertension by a physician, 38% are African American. (4)  Before the 1970s, heart disease was widely believed to be uncommon in African Americans.  It is now recognized that heart disease mortality rates for African Americans exceed those of whites age 25 to 64 and are similar to the rates of whites for all ages combined. (5) Cardiovascular disease accounts for 26.6% of the identifiable excess mortality among African American males in comparison with white males.(4) One reason for the excess mortality is poor access to care. (4)   Women with Heart Disease Heart disease is the leading cause of death in women in the United States.(1)  Overwhelming evidence supports the view that African American women, especially those residing in the South, experience higher heart disease death rates than women of other ethnic, racial, and geographic origins.  Approximately 40 women per 100,000 across the United States die from heart disease each year, and more than 6.5 million American women alive today have suffered a myocardial infarction (heart attack) or angina pectoralis(chest pain or discomfort).(6) As a woman ages, the risk of myocardial infarction increases, as does the likelihood of death and disability from a myocardial infarction. (6) The burden of heart disease is highest among African American women followed by Caucasian, Hispanic, American Indian and Alaskan Native, and Asian and Pacific Islander women, in that order. (6)     Quote Byrd wrote in 1991, “Rising racial differentials...in infant mortality, maternal mortality, cancer survival, cardiovascular mortality, childhood immunization rates, hospitalizations, and length of stay all indicate that African Americans are not receiving adequate high-quality basic health services.” (7)   Back to Top Possible Causal Factors of Coronary Heart Disease BMI=Body Mass Index Obesity is an independent predictor of Coronary Heart Disease (CHD), which is the major cause of death and disability in older persons.(8) It is also the major source of health care expense in men and women over the age of 65.(9)   The National Health and Nutrition Examination Survey (NHANES) indicated that African Americans have a lower intake of calcium than whites.  High nutritional intake of calcium is a possible protective factor for hypertension.(2) For more information, go to Nutrition. Minorities receive different cardiac care from non-minorities... A review of racial and ethnic differences in cardiac care from 1984-2001 compiled by the Henry J. Kaiser Family Foundation in October 2002 found that of the 81 studies investigated, 68 find racial and ethnic differences in cardiac care for at least one minority group.  Of the 68, 46 find differences in cardiac care for all of the procedures and treatments investigated, and 22 find differences in cardiac care for some procedures and treatments and not others.  The 13 remaining studies include 11 that find no racial or ethnic differences in cardiac care, and two that find the racial and ethnic minority groups more likely than whites to receive appropriate care. (10)   For more information on what those differences are, check out the article or do a PubMed search. Cost In 2003, the cost of heart disease and stroke is projected to be $351 billion: $209 billion for health care expenditures and $142 billion for lost productivity from death and disability. (11)   Back to Top References 1. Piane G. A comparison of the effect of a hypertension education program among black and white participants. J Health Care Poor Underserved 1990;1(2):243-53. 2. Amercian Heart Association (AHA). Heart Disease and Stroke Statistics-2004 Update. Dallas, Texas: AHA, 2004. http://www.americanheart.org 3. Buchowski MS, Sun M. Nutrition in minority elders: current problems and future directions. J Health Care Poor Underserved 1996;7(3):184-209. 4. Thomas DJ, Thomas J. Black male physicians at risk. J Health Care Poor Underserved 1993;4(1):1-5. 5. Lewis CE, Raczynski JM, Oberman A, Cutter GR. Risk factors and the natural history of coronary heart disease in blacks. Cardiovasc Clin 1991;21(3):29-45. 6. Andrews JO, Graham-Garcia J, Raines TL. Heart disease mortality in women: racial, ethnic, and geographic disparities. J Cardiovasc Nurs 2001;15(3):83-7. 7. Byrd WM, Clayton LA. The 'slave health deficit'. Racism and health outcomes. Health PAC Bull 1991;21(2):25-8. 8. Harris T, Cook EF, Kannel WB, Goldman L. Proportional hazards analysis of risk factors for coronary heart disease in individuals aged 65 or older. The Framingham Heart Study. J Am Geriatr Soc 1988;36(11):1023-8. 9. Neill WA, Branch LG, De Jong G, et al. Cardiac disability. The impact of coronary heart disease on patients' daily activities. Arch Intern Med 1985;145(9):1642-7. 10. Lillie-Blanton M, Rushing OE, Ruiz S, Mayberry R, and L Boone. Racial/Ethnic differences in cardiac care: The weight of the evidence. Henry J. Kaiser Family Foundation. October 2002. 11. National Center for Chronic Disease Control and Prevention. Preventing Heart Disease and Stroke. Atlanta, GA: CDC, 2005. http://www.cdc.gov/nccdphp/bb_heartdisease/ This research was supported by a National Library of Medicine (NLM) Publication Grant #5G08 LM07653-02 in support of the creation of a web site titled Factline: Tracking Health in Underserved Communities, www.factline.org. Saqi S. Maleque, MSPH, Researcher, Principal Investigator: Virginia Brennan, PhD.