When I see one of my heart patients, I keep in mind that this individual is part of a family, part of a community.
As a community, African-Americans have higher rates of high blood pressure, high cholesterol, obesity, and diabetes – the four major risk factors for heart disease. For instance, 57 percent of adult African-American women are obese, compared to 34 percent of non-Hispanic white women, according to the Centers for Disease Control and Prevention.
Teasing out the reasons for these risk factor differences is difficult. If everyone in a family has high blood pressure, does that mean it’s genetic, or does that mean everyone in the family is leading a similar lifestyle?
Certainly, genetics appears to play some role. Some studies suggest that African-Americans are particularly sensitive to salt, which can lead to high blood pressure. But much of the difference is likely lifestyle, which is influenced by a variety of elements, including socioeconomic status, education, environment, stress levels, culture, and history.
As an example of how history can affect health, let’s focus on weight for a second. Research from UT Southwestern has shown that many people in the African-American community, particularly older individuals, believe that a heavier weight is a healthier weight. Historically, there were good reasons to believe this. Having extra weight could feasibly offer protection against things people used to be susceptible to, such as infectious disease and not having enough food.
But we Americans aren’t dying excessively from infectious diseases these days. Now we’re dying of heart disease, and we need to change our perception of what healthy looks like – literally.
Role of economics, stress
Economics and stress levels often play a role in high blood pressure. Fresh fruits and vegetables may not be readily available to those with limited access, and it takes time, money, and resources to lead a healthy lifestyle. Additionally, prepackaged foods and fast foods are filled with excessive salt, which adds to the difficulty of controlling blood pressure. Unfortunately, this usually means it will take multiple medications to achieve adequate control.
Cultural norms can affect even how we exercise. Building up your biceps does not help protect your heart. Although resistance training is important, exercise should be cardiovascular. You’ve got to be able to walk a mile, run a mile.
If you are an African-American and heart disease runs in your family, I urge you to see a general physician or preventive cardiologist in your 20s to discuss a healthy weight for you, to make sure your blood pressure levels are normal, and to make a plan for healthy eating and exercising.