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Women and Heart Disease - Race and Ethnicity Matters

Women and Heart Disease - Race and Ethnicity Matters

By Dr. Tori Hudson

Heart disease impacts us all - it’s the leading cause of death in both men and women, accounting for 1 out of every 4 deaths.1 Your gender, race and ethnicity, lifestyle, and even zip code can all play a part in your heart health and the healthcare available to you. With so many factors impacting your heart health, it’s important to know your own personal risk factors for heart disease.

The term “heart disease” refers to many things, but here we are focusing on heart attack and coronary artery disease, or atherosclerosis - which is the narrowing of the arteries due to the buildup of plaque which is caused by fat, cholesterol and calcium. Arteries are the blood vessels that carry oxygen and nutrients from your heart to the rest of your body, so it is critical they are not closed by plaque and vascular inflammation.

Despite a great deal of public health education over the past few decades, only about 50% of women recognize that heart disease is, in fact, the number 1 cause of death in women, not breast cancer or any other women’s health issue.2 And, as we collect more data and develop a deeper understand of our national demographics, we are learning that your race and ethnicity matter.

Certain minority groups in the US face significantly greater risk and these differences appear to be due to an increased prevalence of high blood pressure, diabetes and obesity seen in non-white American women. But that’s not all. There are also the influences of genetics, socioeconomic status, stress, access to healthy food, access to safe places to exercise, access to quality of healthcare, and the challenge of potential communication barriers. This is so impactful that experts in public health are often quoted as saying that your zip code is one of the most important determining factors for health and life expectancy. For example, racial and ethnic minorities in the U.S. confront more barriers to cardiovascular disease diagnosis and medical care, receive lower quality of treatment, and experience worse health care outcomes than Caucasians.

African American

According to the CDC, almost half of all African American men and women have some form of cardiovascular disease compared with about one third of Caucasian men and women.3 Sadly, even after adjusting for factors related to socioeconomic status and differences in rates of heart disease and its risk factors, African American’s still have a higher risk of heart disease than Caucasians. Genetic vulnerability and inherited health issues of high blood pressure are more prevalent in African Americans and might play a role. One of the theories is that people who live in equatorial Africa have developed a genetic predisposition to retain more salt, which actually helps them to conserve water in the hot and dry climate. American descendants have likely retained this genetic predisposition, but their environment and lifestyle has changed.4

Hispanic and Latino

While Hispanics and Latinos have higher rates of obesity, diabetes, and other cardiovascular risk factors compared with Caucasians, they actually have about a 25% lower likelihood of dying from heart disease. However, Hispanics and Latinos are about 50% more likely to die of diabetes than Caucasians.4 What could explain this paradox? One possibility is the under reporting of heart disease rates in Hispanics and Latinos, with another theory being the strong religious, cultural and family support dynamics still prevalent in Latin communities.5

Asian

Of the seven subgroups of Asian Americans in the U.S., Asian Indians, Chinese, and Filipinos have the largest communities. Heart disease rates vary widely among these groups. Those from South Asia tend to have higher rates of coronary artery disease, yet recent immigrants from East Asian countries tend to have lower rates of heart disease than other Americans. However, interestingly, the first-generation children of East Asian immigrants, who often adopt a Western diet and lifestyle, end up with higher rates of obesity and other cardiac risk factors.4

Statistics that impact us all

Gender Matters: Heart disease is the leading cause of death for women in the United States, killing 299,578 women in 2017—totaling about 1 in every 5 female deaths.2

Location Matters: According to the CDC women living in the south have a much higher risk of dying from heart disease, as do poorer communities irrespective of race.2

Race and Ethnicity Matter: Statistics on heart disease by ethnicity and race from the CDC

  • Heart disease is the leading cause of death for African American and Caucasian women in the United States.2
  • African American individuals are nearly twice as likely to have a stroke, and are much more likely to die from a stroke than Caucasians.2
  • Among American Indian and Alaska Native women, heart disease and cancer cause roughly the same number of deaths each year. They also die from heart disease much earlier than expected, with 36% being under the age of 65 compared with only 17% for the U.S. population overall.2
  • For Hispanic, Asian or Pacific Islander women, heart disease is second only to cancer as a cause of death.
  • Mexican-Americans, American Indians and Alaska Natives have a higher prevalence of diabetes than non-Hispanic whites for adults over age 20. Diabetes increases the risk of cardiovascular disease significantly.2
  • A U.S. census report from 2007 stated that more than half of the uninsured people in the U.S. are people of color.8
  • Non-Hispanic blacks, Mexican-Americans, American Indians and Alaska Natives have a higher prevalence of diabetes than non-Hispanic whites for adults over age 20. Diabetes increases the risk of cardiovascular disease significantly.2
  • Black individuals are nearly twice as likely to have a stroke and are much more likely to die from a stroke than white adults.2
  • About 1 in 16 women age 20 and older (6.2%) have coronary heart disease, the most common type of heart disease:

- About 1 in 16 white women (6.1%), black women (6.5%), and Hispanic women (6%)

- About 1 in 30 Asian women (3.2%)2

Key risk factors for heart disease include: high blood pressure, high LDL (low-density lipoprotein) cholesterol, and smoking. About half of all people in the United States (47%) have at least one of these three risk factors.2

Several other medical conditions and lifestyle habits put women at higher risk for heart disease:

  • Diabetes - Adults with diabetes are 2 to 4 times more likely to die from heart disease than those without diabetes.7
  • Being overweight or obese - Obesity can change the structure and function of the heart. Healthy weight management can help improve your heart health.2
  • Diet - Eating an unbalanced diet with foods high in sugar, unhealthy fats, and cholesterol can contribute to the development of heart disease.9
  • Physical inactivity - A little exercise can go a long way. According to a Cleveland Clinic article, simple lifestyle changes like moving more can potentially reduce the risk of dying from heart disease by as much as 40 to 50 percent.10
  • Consuming too much alcohol (more than 1 drink per day) - According to UC San Francisco researchers, it is estimated that the complete eradication of alcohol abuse could result in 91,000 fewer congestive heart failure patients in the US.11

In summary, while race and ethnicity without a doubt matter due to a multitude of genetic, socioeconomic, discriminatory, dietary and lifestyle, and environmental reasons, (not to mention access to quality healthcare), what is even more important – as we become increasingly integrated and multicultural – is that we examine our health on an individual basis and consider all the very unique factors that impact us personally. Only then can we consider the exact steps required for our individual health. All of this information plays a part in empowering us to know where we are at now, as well as providing us with details of what we each need to be aware of in order to create a healthy future. Our health is not limited to a demographic. This is why working with a health professional who can understand, support, and guide your individual needs is so important. Only then can they be precise and exacting rather than relying on generalizations that don’t necessarily consider your individual genetics, ancestry, past and current circumstances.

If you’re seeking an integrated functional health professional to support you in your health journey, or just a second opinion, please fill out our Find A Doctor form so that we can support you.

Also, sign up for our newsletter as next week we will post a complete Heart Health Guide by our Medical Team, looking in detail at cardiovascular health.

Dr. Tori HudsonAbout the Author:

Dr. Tori Hudson is a world renowned Naturopathic Physician with over 30 years of expertise in women’s health, primary care, gynecology and endocrinology.

Since graduating from the National University of Naturopathic Medicine in 1984 Dr. Hudson has been the medical director of her clinic, A Woman’s Time in Portland, OR, as well as the founder and co-director of the nonprofit accredited naturopathic residency program - Naturopathic Education and Research Consortium.

Dr. Hudson was the first Woman in the United States to become a full professor of Naturopathic Medicine. She has served the National University of Naturopathic Medicine as a Professor, Medical Director, Associate Academic Dean, and Academic Dean. She is currently an adjunct clinical professor at NUNM, Southwest College of Naturopathic Medicine and Bastyr University.

Dr. Hudson is the author of the Women’s Encyclopedia of Natural Medicine, a bestselling naturopathic book on Women’s Natural Health, and a contributor to the textbook of Natural Medicine, third edition; Integrative Women’s Health. She is a nationally recognized author, educator, speaker, clinician, researcher, and a member of Symphony Natural Health’s Medical Team.

References:

  1. CDC (2019). Heart Disease Facts. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/heartdisease/facts.htm
  2. CDC (2020). Women and Heart Disease. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Retrieved from https://www.cdc.gov/heartdisease/women.htm
  3. Katherine Kam (2010). Why Are African-Americans at Greater Risk for Heart Disease? African-Americans are at higher risk for heart disease, yet they're less likely to get the care they need. WebMD Retrieved from https://www.webmd.com/heart-disease/features/why-african-americans-greater-risk-heart-disease#1
  4. Harvard Heart Letter (2015). Race and ethnicity: Clues to your heart disease risk? Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/heart-health/race-and-ethnicity-clues-to-your-heart-disease-risk
  5. Egolf, B., Lasker, J., Wolf, S., & Potvin, L. (1992). The Roseto effect: a 50-year comparison of mortality rates. American journal of public health, 82(8), 1089–1092.
  6. CDC (2019). Know Your Risk for Heart Disease. National Center for Chronic Disease Prevention and Health Promotion , Division for Heart Disease and Stroke Prevention. Retrieved from https://www.cdc.gov/heartdisease/risk_factors.htm
  7. AHA (2015). Cardiovascular Disease and Diabetes. American Heart Association. Retrieved from https://www.heart.org/en/health-topics/diabetes/why-diabetes-matters/cardiovascular-disease--diabetes
  8. United States Census Bureau. Retrieved from https://www.census.gov/quickfacts/fact/table/US/PST045219
  9. Heart Disease: Facts, Statistics, and You. healthline. Retrieved form https://www.healthline.com/health/heart-disease/statistics#1
  10. Cleveland Clinic (2016). How Much Exercise is Best for Heart Health? Americans Aren’t Sure. Cleveland Clinic Newsroom. Retrieved from https://newsroom.clevelandclinic.org/2016/02/01/much-exercise-best-heart-health-americans-arent-sure/
  11. Scott Maier (2017). Alcohol Abuse Increases Risk of Heart Attack, Atrial Fibrillation and Heart Failure. University of California San Francisco. Retrieved from https://www.ucsf.edu/news/2017/01/405346/alcohol-abuse-increases-risk-heart-attack-atrial-fibrillation-and-heart-failure

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