- Cardiovascular disease (CVD) causes more than a quarter of all deaths worldwide.
- However, the risk of death from CVD varies greatly with ethnicity.
- Rates of heart disease are higher in African Americans than in any other ethnic group in the United States.
- New research suggests that racism is associated with higher rates of heart disease in Black women.
Two cardiovascular diseases (CVDs) — ischaemic heart disease and stroke — are, according to the World Health Organization, the leading causes of death worldwide. Together, they are responsible for 27% of the world’s total deaths.
The CDC advises that the risk of CVD is increased by several factors:
- high blood pressure, or hypertension
- unhealthy levels of cholesterol
- diabetes
- obesity
- lifestyle factors, such as a diet high in saturated fats, lack of physical activity, smoking and excessive alcohol intake.
However, genetics and race also play a part in the risk of heart disease. Although heart disease death rates have been falling in the United States since 1999, these rates remain higher for Black people than for other ethnic groups.
There may be many reasons for this. Black people have higher rates of some of the risk factors for heart disease, such as hypertension and type 2 diabetes. And health inequity for People of Color in the U.S.—which contributes to lower life expectancy, higher blood pressure, and strains on mental health—may be, in part, due to racism.
Now, a new study, presented at the American Heart Association sessions, has suggested that structural racism may contribute to higher rates of heart disease in Black women.
Racism, stress and heart disease
A 2003 study found that racism can limit socioeconomic mobility, which may adversely affect cardiovascular health. In addition, it suggested that perceived racism is a stressor that can induce psychophysiological reactions that negatively affect cardiovascular health.
Another study, in 2014, found a small, significant association between perceived racial discrimination and hypertension, and suggested that perceived discrimination might partly explain racial health disparities.
According to the British Heart Foundation, stress alone won’t cause heart and circulatory disease, but it is linked to unhealthy habits that can increase your risk.
Dr. Shanshan Sheehy, Sc.D., lead author of the study and an assistant professor at the Slone Epidemiology Center at Boston University and Boston University’s Chobanian & Avedisian School of Medicine said:
“Current evidence shows that racism may act as a chronic stressor in the human body, and chronic stress may lead to high blood pressure, which increases the risk of heart attack and stroke.”
“The relationship between racism and stress is well studied, including the weathering hypothesis and the epigenetic effects of racism on health across generations. So, this longitudinal study is really relying on the tenets of this theory that shows that stress (allostatic load) biologically ages the body in ways that leads to poor health outcomes.”
— Dr. Maranda C. Ward, assistant professor of clinical research and leadership, GW School of Medical & Health Sciences, who was not involved in the study.
Structural racism
“This study assessed the structural/systemic forms of how racism gets codified in housing, employment and policing — it is patterned, there are scores of evidence demonstrating how racism shows up in these laws and practices.”
— Dr. Maranda Ward
The researchers followed 48,305 participants in the Black Women’s Health Study from 1997 to 2019. During that time, 1,947 women developed coronary heart disease.
They calculated a score for self-perceived interpersonal racism in everyday life by averaging participants’ responses to five questions, such as “How often do people act as if they think you are dishonest?”
They found no association between perceived racism in everyday life and CHD.
However, when looking at perceived racism in interactions involving employment, housing and the police, they found very different results.
Women who experienced self-reported interpersonal racism in employment, housing and interactions with the police had a 26% higher risk of coronary heart disease than those who did not report interpersonal racism in those areas.
“I actually think that experiencing perceived racism in housing, employment and policing is an indication of structural racism as opposed to interpersonal racism (which explains why the scores were low or not statistically significant when accounting for everyday racism in daily interactions).”
— Dr. Maranda Ward
Why perceived racism?
Dr. Ward called the study very important and necessary, but told Medical News Today:
“I take issue with qualifying racism as ‘perceived’. It leaves room to dismiss one’s experiences with racism or attempt to justify, defend or explain it away with ‘oh that’s their opinion’, as if a Black woman’s lived experience is not valid in and of itself.”
“Now, there really is no value in adding ‘perceived’ because it’s implied when we learn that the study relied on self-reported survey data so no matter what the study variable is — if we were talking about mental health, access to reliable transportation or preferred salad dressing — it would all be self-reported data and therefore one’s perception,” she added.
Future research directions
The researchers acknowledge that there were limitations to the study. Racism was self-reported and individuals may have different perceptions of racism. The information was collected from the participants only once during the 22 year study.
And as an observational study, despite the researchers taking many environmental and social factors into account, there may have been unmeasured factors that influenced the result.
The authors state that their “findings support the hypothesis that experiences of racism may explain some of the disproportionately high incidence of CHD in the Black population.”
And Dr. Sheehy suggested directions for further research in this area:
“Future research is needed to examine the impacts of structural racism on cardiovascular health, [as well as] to evaluate the joint impacts of perceived interpersonal racism and structural racism.”
These findings may have implications for cardiovascular health in Black women. But they also further highlight inequities in health that must be addressed.
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