By Kiara Doyal, The Seattle Medium
February is Heart Disease Awareness Month in the United States, a time dedicated to increasing awareness of a condition that remains the leading cause of death worldwide. While heart disease affects people across all backgrounds, Black Americans experience higher rates of the disease compared to white Americans, a disparity influenced by multiple factors.
According to Dr. Lara Oyetunji, a cardiothoracic surgeon at the University of Washington Medical Center, the prevalence of obesity, hypertension, and kidney disease among Black individuals significantly increases their chances of suffering from heart disease.
“I think it is multifactorial. Black patients absolutely have higher rates of obesity, hypertension, and coronary kidney disease. The rates of kidney disease are almost four times higher, and kidney disease is related to hypertension,” said Oyetunji. “Sixty percent of Black males and close to 55% of Black females have high blood pressure. Seventy percent of Black males are overweight or obese, and close to 80% of Black females are overweight or obese.”
These risk factors often develop early in life and persist into adulthood, contributing to the higher prevalence of heart disease in Black communities.
“The problem starts young, and then it perpetuates during adulthood. We do absolutely have higher rates of all the individual risk factors, which leads to the higher prevalence,” Oyetunji said.
While there are many factors that can lead to heart disease, Oyetunji says that coronary artery disease (CHD) is the most common form of heart disease, occurring when the arteries supplying blood to the heart narrow or harden from the buildup of plaque.
“The major drivers for heart disease are diabetes, hypertension, high cholesterol, kidney disease, and obesity,” said Oyetunji. “CHD is the most common type, but it could be valvular, or it could be due to blockages in the arteries that actually supply the heart.”
Addressing the disparities in heart disease requires raising awareness, as prevention is significantly more effective than treatment.
“The biggest thing is awareness,” said Oyetunji. “I really do think that awareness for Black patients themselves and empowering them to take charge of their health is huge. Because once you lose it, it is very hard to get back, and it is easier to prevent heart disease than it is to treat it.”
Oyetunji says that being aware of your family history when it comes to heart disease early is a very important factor in prevention and early detection. With this knowledge, early detection can occur before symptoms like shortness of breath, palpitations, and coughing appear.
“Early knowledge and early detection of high blood pressure before it leads to kidney disease or stroke is important. Knowing your personal risk factors is when genetics comes into play,” she said. “If you know that your family has a history of diabetes and high blood pressure, then you already know that you are predisposed to that. Knowing what your blood pressure is, getting regular checkups, knowing what your hemoglobin A1c is, and absolutely tracking your weight. When you know what is going on with you, you are empowered to make changes.”
“Even if you need medications to control your high blood pressure, so be it. It is better to be on a medication and have well-controlled blood pressure than to have hypertension,” Oyetunji added.
While Black people generally experience higher rates of heart disease compared to white people, Black women face an even greater disparity, which becomes apparent when considering the full range of heart-related conditions. According to the National Institutes of Health (NIH), Black women are twice as likely to have a stroke compared to white women.
“A stroke is different than heart disease, but Black women are more likely to have a stroke,” said Oyetunji. “For Black women in particular, they are more likely to report more stomach symptoms than they are chest symptoms compared to white women, and that same process that leads to heart disease can lead to a stroke.”
Despite having increased risk factors for heart disease, Oyetunji said that inequities in access to care and treatment play a huge role in Black people’s heart health outcomes.
“There is implicit bias, which has been documented in a Harvard study,” Oyetunji said. “This implicit aptitude test was developed by Harvard, and they found that there was anti-Black bias in a lot of physicians who treat Black patients, which impacts how they are being treated. How do you actually manage the patient in front of you who is having a heart attack? It all stems from the biases that we do not even know that we have. If you just treat everyone the same, then that sort of helps decrease the impact that implicit bias can have.”
Oyetunji also pointed to the underrepresentation of Black physicians as a contributing factor. While Black Americans make up about 14% of the U.S. population, they represent less than 5% of the medical workforce and fewer than 3% of cardiologists.
“There are studies that have shown that patients tend to trust the people who look like them,” Oyetunji said. “A lot of Black patients who have the stress of the medical system do not trust what their physicians are telling them. When I see a Black patient, at the end of the visit, there is this sigh of relief from them that they are so glad that I am their doctor, and it is sort of this unspoken trend that I see plainly.”
“They see me, a Black woman and a cardiothoracic surgeon, and then there is like this sigh of knowing I [the patient] am going to be well taken care of. I don’t have to worry about what the doctor is telling me because the doctor is watching out for my best interest,” she continued.
Despite her expertise as a cardiothoracic surgeon, Oyetunji acknowledged that even she would face challenges navigating the healthcare system as a Black woman, reinforcing the need for greater awareness and advocacy.
“I am a Black female, and I am aware that if I were to present with heart disease, I am less likely to get the standard care. Despite my education,
despite my socio-economic factors, I am still a Black woman in America, and I know that my outcomes would be worse than a non-Black person,” Oyetunji said. “That is sobering and really fuels me to sort of disseminate the information as much as I can. Raising awareness to help essentially myself, but also people who look like me, is why I do it.”
