Not So Silent Killer – The Spiraling Effects of Heart Disease Among African Americans

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For decades, heart disease has cut a wide swath through the health and well-being of American society. Over 70 million Americans are living with a form of heart disease, and it is the most likely cause of death. Statistics for African Americans are particularly dire. Of 5 million individuals diagnosed with heart disease, 725,000 are African American, with an estimated increase of 900,000 expected by the end of the decade. Although risk factors are identical across racial groups, blacks present multiple factors and symptoms are likely to be more advanced and aggressive. In 2003, American Heart Association statistics showed an alarming 41% of black males and 44.7% black females had cardiovascular disease compared to 34.3% and 32% of white respectively. The harsh social and economic realities of African American life have exacerbated the onslaught of the disease, towards which we are seemingly predisposed. Despite this, blacks remain the most underrepresented and under served population in research studies, clinical trials and treatment. Black women, who have the highest risk factors, remain the lowest on the healthcare ladder for diagnosis and life-saving tests and treatment and are 69% more likely to die from a heart attack or stroke than white women. Grim health outcomes notwithstanding, it is possible to reverse medical predictions to achieve and maintain optimum health through education and positive lifestyle changes.

Risk Factors

The risk factors for heart disease are as follows: hypertension; family history; cigarette smoking; diabetes; obesity; high blood cholesterol and physical inactivity. Previously, increasing age and gender were determining factors; though this is no longer true as the disease has been diagnosed at increasing younger ages. Each year, 40,000 more women than men suffer strokes and women account for 51% of the total heart disease. Secondary risk factors are high levels of triglyceride, the most common type of fat in the body which accelerates to high cholesterol and diabetes; excessive alcohol in-take and previous heart attack or stroke.

Risk factors and symptoms tend to be higher and more destructive in blacks. For example, a black, female diabetic, with attendant factors of obesity and a sedentary lifestyle, may be so far advanced that a limb may need to be amputated. Dr. Malcolm Taylor, MD, Assistant Clinical Professor for University Medical Center, in Mississippi, Director of the Congestive Heart Failure Clinic at St. Dominic-Jackson Memorial Hospital and former President of the Association of the Black Cardiologists explains, “Diabetes is not only a disease involving glucose, it also causes premature aging of the blood vessels. That’s why the number one cause of death for diabetics is cardiovascular diseases.” The virulence of the risk factors have led researchers and genetic scientists to explore the existence of intrinsic biological determinants or a human genome that make blacks more naturally predisposed susceptible to certain chronic illness such, genes for salt retention that causes hypertension and another for that exacerbates diabetes.

The prevalence of hypertension in African Americans is the highest in the world and plays a significant role in cardiovascular complications. Clinical Director of the Hypertension and Vascular Biology and Head of the Hypertension Division of Cardiology at the University of Maryland School of Medicine in Baltimore, Maryland and a founding member of the Association of Black Cardiologist, Dr. Elijah Saunders asserts that one African-American dies as a result of high blood pressure every hour in the US, which is nearly twice as often as whites. “Blacks also develop high blood pressure at younger ages than whites and suffer more damage to their organs as a result of the disease.” The pressure of stressful life experiences negatively impacts cardio vascular health. In today’s fast-paced, competitive environment, a number of external components contribute to elevated blood pressure including social-economic factors such as career pressure, lack of or underemployment, substandard living conditions and racism. In addition, lack of adequate healthcare and shoddy management of chronic illnesses paves the way for long-term heart failure. Stress stimulators often trigger the development of calcification which causes injury to the cells. The accumulated calcium becomes a marker for aththerosclerosis, a thickening and hardening of artery walls which eventually blocks the arteries.

The culture of eating, not to nourish but to fuel the body, is a particular egregious contributor to cardiovascular disease, which relates to the arteries and vessels within the cardiac system. While many Americans are aware that poor nutrition and lifestyle are not conducive to optimal health, cultural practices are difficult to break. Fried and starchy foods, heavy salt intake, dairy, unsaturated fats and high cholesterol meals – staples of traditional African American cuisine – are major causes of aththerosclerosis. Over time, the accumulation of hard-to-process foods particles creates a blockage in the vessels which eventually compromises the arterial walls. Americans’ increasing corpulence and ever-expanding waist line also weighs heavily. Lisa Jubilee, nutritionist and co-founder of Living Proof, Nutrition and Fitness Center in New York City says, “We’re observing the phenomenon of the skinny, fat person who looks great dressed up and doesn’t weigh much, but have substantial fat deposits stored in their midsection causing an apple shape.” The abdominal fat causes heart disease by pressing into the internal organs and decreasing the oxygen supply to various parts of the body.

Yo-yo dieting is also vicious enemy to the heart and the body’s metabolic system. The shock of food deprivation and supply places substantial stress on the body and hinders its ability to lose weight naturally. Jubilee explains, “Your body doesn’t care if you’re trying to lose weight or build muscle, its main focus is survival. Therefore it will try to find nutrients however it can, even it means metabolizing muscle which will then cause atrophy.” Gradually, vacillating dieting habits weakens the heart muscles and leaves other organs susceptible to cardiovascular disease.

What to Look For: Symptoms and Signs

The body sends a number of signals to the individual to bring about life-saving change. One of the most flagrant signals is a transit ischemic attack (TIA) or “mini stroke.” Dr. Donna Mendes, Chief of Vascular Surgery at St. Luke’s Roosevelt, Uptown in New York City, Clinical Professor of Surgery at the College of Physicians & Surgeons, and the first African American female to become board certified in the specialty of peripheral vascular surgery explains, “A TIA occurs when the blood vessel in the brain develops an ulcer caused by high cholesterol. Plaque forms around the crater which eventually breaks off and makes its way through the blood stream towards the brain. The portion of the brain impacted will suddenly experience decreased blood flow, resulting in a TIA.” The part of the body controlled by that portion of the brain becomes impaired, lasting from a few minutes to twenty-four hours. For example, while combing the hair the comb may fall from a person’s hand. Other indicators include loss of sensation on one side of the body, loss of vision, motor function or intermittent pain in the calf after walking, which results from decreased oxygen and blood flow. Peripheral artery disease is also a major element in the development of heart disease. It affects arteries which emanate from the heart, which, when damaged, causes stroke, gangrene or amputation of the lower extremities.

Despite exhaustive studies of heart disease in Caucasians, scientists have only recently begun to study the presentation of the disease in African Americans. Dr. Taylor asserts, “Blacks still receive less cardiovascular care, even for acute symptoms, are less likely to receive EKGs, cardiac testing, bypass surgery or even an aspirin.” Historically considered a man’s disease, women present much milder, vague symptoms than male counterparts, which are often missed by both primary physicians and cardiologists. Because they do not the display the heart clutching, Hollywood version of an attack most associated with heart failure, they are often misdiagnosed or under-treated despite the existence of one or more risk factors. After weeks of persistent breathlessness and vague sense of physical unease, Joan Connell, then 42, an accounting professional at Ziff Davis Publishing, went to the emergency room convinced she was having a heart attack. Despite being an overweight smoker who had been physically inactive for years, she was sent home. A week later she returned with a second heart attack and was rushed into emergency bypass surgery which revealed four blocked arteries.

This year, the National Institutes of Health released the Women’s Ischemic Syndrome Evaluation study (WISE) to address the discrepancy in symptoms between men and women and to assist physicians in identifying and treating the illness in women. Symptoms in men include angina (chest pain), pressure or discomfort in the chest or a tingling sensation in the arm of on one side of the body. Women, however, experience a broader constellation of symptoms over a prolonged period of time. Dr. Patrice Desvigne-Nickens, MD, Head of the Cardiovascular Medicine Scientific Research Group at the National Heart Lung and Blood Institute in Bethesda, Maryland explains, “In the presence of one or more pertinent risk factors, women present a wider set of symptoms for cardiac ischemia which results in heart attack. These symptoms include fatigue; shortness of breath; feelings of indigestion and ill health; palpitations; neck, shoulder and upper back pain; nausea; vomiting; sweating and lightheadedness.”

Connell says that Black women’s superwoman syndrome is detrimental to women’s health and receiving proper care. “We are often over-stressed from working two jobs, taking care of family and juggling multiple responsibilities, the last thing we have time for is taking care of ourselves.” According to Dr. Desvigne-Nickens treatment is time-sensitive therefore the level of damage and the expeditious delivery of treatment plays a significant part in determining the severity of the damage and if the patient survives the attack. Self-care is not selfish. Dr. Desvigne-Nickens says, “Doctors must pay close attention in order to discern symptoms and then order the appropriate test. Women must feel empowered to act quickly to get the necessary treatment.”

Treatment: Cutting Edge Technology, Medication, Protection and Testing

Take heart. Over the years scientists and pharmaceutical companies have developed sophisticated treatment methods, dose-appropriate medications and minimally invasive techniques which have proved effective in the treatment of heart disease. Often EKGs fail to accurately show measure heart defects. Imaging studies have revolutionized how doctors view – and treat – vessel and organ damage.

· Angiography or arteriogram – a procedure that uses X-ray and a special dye to see inside the arteries, veins and heart chambers to detect narrowing or blockage of the vessels. Other forms of angiographies which correspond with various parts of the body include renal, aortic and coronary.

· Carotid Ultrasound – illustrates blood flow and the narrowing of the blood vessels.

· Cardiac Scanning (CT) – examines how well the arteries diffuse blood

· Ankle Brachial Index – predicts the presence and the severity of peripheral artery disease. The patient’s blood pressure is first taken at rest in the arm and in the foot and again several minutes later. A reading under one indicates narrowing of the blood vessel. DR. Mendes also suggests checking the pulse in the groin, behind the knees and in the leg.

· Stress tests – used to determine the amount of stress the heart can manage before developing either an abnormal rhythm or evidence of ischemia. One of the more popular, the treadmill test provides information on how the heart responds to exertion and involves walking on a treadmill or pedaling a stationary bike at varying levels of difficulty, while electrocardiogram, heart rate and blood pressure are monitored.

Because of the under-representation of blacks in the heart disease studies, the FDA has mandated greater minority inclusion in clinical trial. Now there are several medications that mitigate the multiple risk factors. Rimonabant, available in 2007 blocks receptors in the brain that help reduce the risk of heart disease and Type 2 diabetes. Others currently available are designed to raise HDLs (good cholesterol) and lower plaque. Dr. Taylor explains, “Patients’ response is dose-dependent. African Americans tend to need higher doses to get better results and greater cardiac benefit.

· BiDil has been specifically shown to reduce mortality, hospitalization and improve quality of life.

· Beta Blockers lowers blood pressure, treats chest pain and assist in the recovery of heart attack survivors.

· Ace Inhibitors and angiotensin dilates the blood vessels to improve the amount of blood the heart pumps and lower blood pressure. ACE inhibitors also increase blood flow, which helps to decrease the amount of work the heart does.

In addition to angioplasty (inserting a balloon) and stents, minimally invasive surgeries have transformed heart disease treatment, resulting in shorter hospitalization and recovery time, improves medical outcomes, causes less complications and trauma and is more economical.

· Off-Pump Bypass (beating heart surgery) is performed on a beating heart and reduces the risk of medical complications including stroke, bleeding and renal failure.

· Anjiojet – Saline jets create a powerful vacuum within the artery, breaking up the clots, and removes pieces through a catheter and into a pump.

· Trans-Myocardial Laser Revascularization (TMLR) employs a laser to create blood perfusion channels in the heart that supplements the function of the coronary arteries.

Prevention

A diagnosis of heart disease is not a life sentence nor should it be a source of shame or weakness. It presents everyone with the opportunity to recreate and rejuvenate their life through awareness, proper diet and exercise and healthy lifestyle changes. Reducing controllable risk factors is key.

· The core prevention messages are unchanged. This includes becoming physically active, smoking cessation and maintaining weight level in keeping with one’s height and specific body type.

· Diet. Reduce intake of saturated fats found in dairy, red meats, and organ meats such as liver, kidney, sausage and giblets. Incorporate vegetables and foods in their natural forms such as whole grain and high fiber foods which help unclog arteries. Avoid white foods which have been drained of their nutritional content. This includes bread, sugar and pasta. Avoid products containing high fructose corn syrup contained in sodas and fruit juices.

· Know your numbers – blood pressure, cholesterol, blood sugar – so that you can control your risks.

· Learn how to read food labels. Some processed foods and nutritional bars that contain mysterious fillers.

Analyze the content before consuming the product.

Ultimately, education is key and African Americans must assume greater responsibility for their own health. Dr. Taylor cautions, “A doctor will spend more time with a patient who knows something about their disease.”