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In this article:
Key Points
- As a group, African Americans have high rates of heart disease, which includes CAD, stroke, high blood pressure, and heart failure.
- More than one quarter of Mexican Americans have some form of heart disease.
- People of South Asian descent are at high risk for heart disease, but people of Japanese descent are at low risk.
- Historically, Native Americans had very low rates of heart disease, but today it is the leading cause of death in this group.
Many people are surprised to learn that race and ethnicity may also play a role in heart disease. Some groups of people may be more at risk for heart disease, and other groups may not respond as well to certain treatments.
Race and ethnicity play a role in heart disease
Differences in heart disease can be seen across all ethnic groups. Sometimes the gaps are wide. For example, one study showed that African American women with coronary artery disease (CAD) were two times more likely to have a heart attack than white women. The study also showed that they were twice as likely to die from CAD.1 Even after researchers counted for differences between the two groups, the African American women still had much higher risks.
The study brought up some disturbing issues. African American women had higher rates of high blood pressure, high cholesterol, and diabetes. These women were also less likely than white women to control these risk factors. Despite being at greater risk, the African American women were less likely to be taking aspirin to prevent heart attacks or drugs to lower cholesterol. Although the researchers did not know why aspirin was taken less, they did say that African American women need to have their risk factors for heart disease controlled better.
As a group, African Americans have high rates of heart disease. This includes CAD, stroke, high blood pressure, and heart failure, among other conditions. The American Heart Association (AHA) says that about 40% of both African American men and women have some form of heart disease. In contrast, among white people, the numbers are about 30% for men and 24% for women. Heart disease affects more than one quarter of Mexican American men and women. (The data did not include all Latino or Hispanic groups.)2
While racial groups may be useful, it’s important to remember that they only give a general picture. For example, Asian Pacific Islanders are very diverse. People of South Asian descent are at high risk for heart disease, but people of Japanese descent are not.3 Scientists have found that over the past few decades some groups of people seem to be getting more heart disease. In the past, Native Americans had very low rates of heart disease. However, it is now the leading cause of death in this group, ahead of cancer, accidents, chronic liver disease, and diabetes.4-5
Heart disease is a product of the environment and genes
Scientists have long blamed health differences on environmental (or external) factors, such as diet, income, education, social or economic factors (racism and poverty), and access to health care or quality of treatment. In the past, ethnic minorities have made up a large number of the poor. In addition, lower socioeconomic status has been linked to a higher risk of many diseases such as high blood pressure or atherosclerosis, the buildup of fatty material inside the arteries.6 Learn more in Coronary Artery Disease
The environment is important to look at. But in this age of progress in genetic research, scientists are also studying how genes may affect heart disease within specific racial or ethnic groups.
The National Institutes of Health (NIH) is funding a large project to try and find genes that may cause heart disease.7 This task is part of the larger Multi-Ethnic Study of Atherosclerosis (MESA), which was begun in 2000. The eight-year study will track how heart disease develops in four major US ethnic groups: white people, people of Hispanic descent, African Americans, and Chinese Americans. The MESA study, which includes more than 6,000 people, may help to answer many questions about heart disease.
Other scientists are taking a more specific approach. The medical school at Howard University, a mostly African American campus in Washington D.C., has started a large gene bank called Genomic Research in the African Diaspora (or GRAD) Biobank.8 During the project, DNA will be collected from about 25,000 African American people. The goal is to find out whether genes can be blamed for the higher rates of high blood pressure, stroke, heart disease, obesity, and other diseases in this group.
Other scientists have already found some genetic differences among races. For example, researchers have discovered that 13% of African American people carry a gene change that puts them at greater risk for having a rare kind of abnormal heart rhythm. This gene occurred at a much lower rate in white and Asian people than in Latin subjects.9
New information about the role of genes and race may help find better ways to prevent and treat disease. Some studies have found differences in the way groups of people respond to drugs. For example, research suggests that African American people may not respond as well to some blood pressure drugs, such as beta-blockers and angiotensin-converting enzyme inhibitors.10 As scientists learn more about how certain drugs affect different races, patients may be able to get treatments that work better in their particular group.
As researchers discover genes that can lead to heart conditions, they may find that not all people who have these genes will get the disease. The result may depend on a complex relationship between genes and the environment. What’s more, many genetic trends can be modified by lifestyle changes and medical treatment. For example, people may have genes that make them more likely to have high cholesterol. However, they can take steps that will go a long way toward preventing heart disease by eating well and taking cholesterol-lowering drugs as prescribed by their doctor.
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Sources
1. Jha AK, Varosy PD, Kanaya AM, et al. Differences in medical care and disease outcomes among black and white women with heart disease. Circulation 2003;108:1089-1094. PubMed.
2. Heart Facts 2004 - All Americans and African Americans. Dallas, Tex.; American Heart Association, 2003. Available at: http://www.americanheart.org/downloadable
/heart/1073972265237Heart%20Facts%202004%20All-African%20Am.pdf. Accessed June 16, 2004.
3. Statistical Fact Sheet — Populations, Asian/Pacific Islanders and Cardiovascular Diseases. Dallas: American Heart Association, 2004. Available at: http://www.americanheart.org/downloadable/heart/
1075706941602FS03AS04.pdf. Accessed June 16, 2004.
4. Strong Heart Study Data Book: A Report to American Indian Communities. National Institutes of Health, November 2001. Available at: http://www.nhlbi.nih.gov/resources/docs/shs_db.pdf. Accessed June 16, 2004.
5. Statistical Fact Sheet — Populations, American Indians/Alaska Natives and Cardiovascular Diseases. Dallas: American Heart Association, 2004. Available at http://www.americanheart.org/downloadable/heart/
1075706410097FS02AM04.pdf. Accessed June 16, 2004.
6. Labarthe DR. Groups of Special Concern. Epidemiology and Prevention of Cardiovascular Diseases: A Global Challenge. Gaithersburg: Aspen Publishers Inc.;1998:533-534.
7. Bild DE, Bluemke DA, Burke GL, et al. Multi-ethnic Study of Atherosclerosis: Objectives and Design. American Journal of Epidemiology. 2002;156:871-881. PubMed.
8. College of Medicine and First Genetic Trust Form Biobank: Data to Advance Study of Disease Risks Among People of African Descent. Capstone Online, Howard University, June 2, 2003. Available at: http://www.howard.edu/newsevents/Capstone/2003/June/
news2.htm. Accessed June 16, 2004.
9. Marx J. Pharmacogenetics. Gene mutation may boost risk of heart arrhythmias. Science. 2002;297:1252. PubMed.
10. FDA Issues Guidance on Race and Ethnicity Data. FDA Consumer Magazine, May-June 2003. Available at: http://www.fda.gov/fdac/features/2003/303_race.html. Accessed June 16, 2004.
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