Cardiovascular disease and race: Causes

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According to the same data from the CDC, heart disease death rates overall have fallen for white Americans since 1999. However, the rate of heart disease has remained consistent among Black, Hispanic, and Asian American groups.

Even though white Americans have the highest rate of heart disease diagnosis, they are less likely than Black Americans to die of the disease.

According to the CDC, cardiovascular disease death rates by race in 2017 were as follows:

While anyone can develop heart disease, certain risk factors increase the likelihood. These include:

• age, with the risk increasing after the age of 35 years
• sex, as males are more likely than females to develop heart disease
• a family history of heart disease

However, BIPOC groups have a higher prevalence of certain conditions that raise their risk for developing cardiovascular diseases. These include:

High blood pressure

A 2017 study that examined high blood pressure prevalence across racial and ethnic groups in New York City found significantly lower rates of hypertension among white Americans, with an overall age-adjusted rate of 27.5%. Black Americans had the highest high blood pressure rate at 43.5%, with a rate of 38% among Asian Americans and 33% among Hispanic Americans.

Within each group, there were also significant differences. For example, 43% of people from South Asia and 39.9% from East or Southeast Asia had hypertension.

Inequities

Many factors other than genetics can lead to a higher risk of BIPOC developing high blood pressure, including racism in healthcare and everyday life.

For example, researchers in a 2014 systematic review concluded that exposure to perceived racist behavior could lead to an increase in the risk of developing high blood pressure.

Learn about hypertension in African Americans here.

Obesity

Obesity is a significant heart disease risk factor. It may also signal other risk factors, such as a low-quality diet and an inactive lifestyle.

According to the CDC, 42.2% of white Americans have obesity, which means they have a body mass index (BMI) over 30. The rate for Black Americans is 49.6%, while Asian adults have the lowest rate, at 17.4%. Hispanic adults have the second-highest obesity rate, at 44.8%.

Inequities

Higher poverty rates and residential segregation among BIPOC groups in the U.S. can cause higher rates of obesity. This is partly because they may not have easy access to fresh, healthier food and safe places to exercise.

Diabetes

A 2019 study tracked diabetes rates among 7,575 adults between 2011–2016. The age and sex-adjusted prevalence of diabetes was as follows:

• 22.1% for Hispanic people
• 20.4% for Black people
• 19.1% for Asian people
• 12.1% for white people

Within groups, there was significant variation. For example, 12.3% of South American Hispanic participants had diabetes compared to 21.7% of Mexican participants.

Inequities

These disparities happen due to a number of factors, including:

• lack of access to quality healthcare and checkups
• residential segregation
• higher poverty rates among BIPOC groups
• higher stress rates among BIPOC groups

Learn about how these factors affect African Americans with diabetes in more detail here.

High cholesterol

High cholesterol rates vary by race and ethnicity. The CDC reports that between 2015–2016, rates of high cholesterol were:

Race is a social construct based on skin color rather than genetics or biology. Even where genetic factors do play a role in heart disease, social determinants can affect the severity of the disease and a person’s risk of dying.

Many of the risk factors that can lead to cardiovascular disease or complications from the conditions are preventable and exist because of systemic racism.

A number of modifiable factors could help reduce disparities between groups:

Racial stress

Racism causes chronic stress, which can increase the risk of developing heart disease. This occurs through “weathering,” a term that describes the long-term impact of exposure to racial stress on a person’s overall health.

A 2019 study found that out of 2,694 people, weathering contributed to Black Americans having a biological age that was 2.6 years older than their actual age, while white Americans’ biological age was 3.5 years younger.

Racial stress can contribute to the development of disease, including risk factors for heart disease, such as high blood pressure. Directly experiencing discrimination also has this effect. For example, a 2004 study of heart disease rates in Black Americans found that the perception of racial discrimination at work correlated with developing hypertension.

Access to resources

It can be more difficult for individuals from BIPOC groups to access healthcare in comparison to white people. This is true for a number of reasons.

For example, residential segregation in the U.S. means that predominantly Black neighborhoods have fewer financial resources and are more likely to have shortages of doctors. It can also contribute to food deserts, which refers to areas where it is difficult to get fresh produce, and unsafe public spaces, which can affect a person’s ability to exercise.

Economic inequity also contributes to healthcare being unaffordable for many, making it difficult to access or pay for medical treatment. For undocumented migrants, the fear of deportation can deter people from seeking help.

Racism in medicine

Numerous studies have found that individuals from BIPOC groups receive lower-quality healthcare than white people.

For example, in an older 2010 study of people seeking care for pneumonia, Black people were less likely to receive antibiotics within 4 hours. When they did receive antibiotics, the antibiotics were less likely to comply with treatment guidelines. There is no medical reason for this difference.

A 2018 study found that Black Americans are less likely than white Americans to get care from a cardiologist when they go to the intensive care unit for symptoms of heart failure. Care from a cardiologist correlated with a higher likelihood of survival.

In 2020, the American Heart Association (AHA) emphasized that structural racism is a key driver of disparities in heart disease and heart health outcomes. The organization called for more research on the health effects of racism and urged providers and organizations to examine their role within systemic racism.

One example of an organization that has committed to promoting antiracist policies is The Commonwealth Fund. Measures they call for include:

• Improvements in how doctors help individuals from BIPOC groups with chronic conditions, such as high blood pressure, to control their symptoms. This strategy should address the issues of trust that exist between healthcare professionals and BIPOC.
• More transparency on racial disparities in the treatment of certain conditions by collating and publishing data.
• More information in order to better educate people from all racial groups about factors that could affect their health.
• A better understanding of how structural racism affects the way individuals from BIPOC groups can engage with their treatment and healthcare professionals. This could include an acknowledgment of limited public transport and food deserts.

Systemic and unfair health disparities, or inequities, are something everyone has a responsibility to change. At an individual level, though, there are also things people can do to reduce their risk for heart disease. Where possible, people can try:

• eating a heart-healthy diet that focuses on high-fiber fruits and vegetables, lean proteins, and healthy unsaturated fats, such as olive oil
• exercising regularly
• quitting smoking
• reducing, or stopping, drinking alcohol
• avoiding foods high in saturated fat or added sugar
• monitoring blood pressure to detect early signs of hypertension
• seeking treatment for any chronic conditions or unexplained symptoms
• telling a doctor if a person has a family history of heart disease, so they can monitor them more closely

Learn how to follow a heart-healthy diet here.

In the U.S., the mortality rate for cardiovascular disease is higher among certain racial and ethnic groups than it is among white people. Conditions that elevate the risk of cardiovascular diseases, such as hypertension and obesity, are also more prevalent among BIPOC groups.

Evidence shows that the chronic stress, socioeconomic inequity, and discrimination caused by racism all contribute to this disparity.