Racial Disparities Persist in Heart Disease Deaths, Outcomes

Heart failure and hypertensive heart disease deaths are increasing among black men and women despite advances in heart disease management, highlighting persistent racial disparities that should be addressed, according to a study published in the British Medical Journal (BMJ).

The age adjusted mortality rate for heart diseases in the US declined by more than 50 percent in the second half of the 20th century, researchers noted. This reduction was partly due to rapid declines in mortality from ischemic heart disease, resulting from prevention efforts and evidence-based treatments.

Although mortality rates continued to decline after 2000, mortality for heart disease plateaued in 2011. Some indicators also suggest a reversal in the trend, with increasing rates of death from heart disease in certain population subgroups or in particular regions of the US.

The team examined standard data collected from death certificates across the country to identify trends across time in deaths from leading causes of heart disease deaths: ischemic heart disease, heart failure, heart disease related to high blood pressure, valvular heart disease, arrythmias, and other heart diseases.

Researchers analyzed these trends among black and white men and women across age groups and in urban and rural areas.

The group found that between 2011 and 2018, the death rate due to heart disease declined by 0.7 percent per year. Over this same time period, the death rate due to ischemic heart disease declined by 2.6 percent per year. However, these gains were offset by significant increases in deaths due to heart failure (3.5 percent per year) and hypertensive heart disease (4.8 percent per year).

In total, deaths from heart disease in 2018 accounted for 3.8 million potential years of life lost, with 30 percent greater years of life lost for black men than white men, and 60 percent greater years of life lost for black women compared to white women.

The results reveal that although healthcare has made strides in heart disease care and management, significant racial disparities exist.

"These findings are alarming," said senior study author Dr. Sadiya Khan, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.

"Despite medical and surgical advances in heart disease management and public policy initiatives around blood pressure awareness, we are losing ground in the battle against heart failure and hypertension. And the disparities in heart disease are clear."

While the disparities observed in heart failure and hypertensive heart diseases are likely due to higher rates of high blood pressure, obesity, and diabetes in black populations, healthcare leaders must examine the underlying reasons for these conditions.

"We have to recognize and address that the root causes of these disparities arise from differences in social determinants of health, such as socioeconomic status and access to care, and structural and systemic racism in our country," Khan said.

"These findings should be a wake-up call that without equitable access to care and community-engaged implementation of evidence-based therapies for the people who need them, we will not be able to reverse these unfavorable trends.”

Previous studies have uncovered racial disparities in heart failure treatment and diagnosis. A 2019 study published in JAMA showed that a genetic variant found in people of African American or Latino ancestry was significantly associated with heart failure, suggesting under-recognition and under-diagnosis of this condition.

“It is imperative to identify patients at risk for the disease and intervene before noticeable symptoms of the disease appear,” said study author Ron Do, PhD, Assistant Professor of Genetics and Genomics Sciences, and co-Director of the BioMe Phenomics Center in The Charles Bronfman Institute for Personalized Medicine at the Icahn School of Medicine at Mount Sinai.

“Previous studies have proposed utilizing routine genetic testing for individuals with African ancestry; however, this is not current practice and the scope of the under-diagnosis is not clear.”

Northwestern University researchers who conducted the BMJ study noted that understanding which types of heart disease are increasing and in which groups can help inform targeted, equitable prevention efforts, especially for heart failure and hypertension.

"These findings emphasize the urgency with which we need to change how we are approaching cardiovascular health, which continues to be reactive and shift towards a proactive/preventive approach," Khan said.

"We need to set up the systems and resources to help our patients preserve and protect their heart health. We needed this before the COVID-19 pandemic and the need is even more urgent with disparities in the context of the current pandemic. People with high blood pressure or obesity have more severe outcomes related to COVID-19. This might portend even greater increases in heart disease deaths in the long-term among people who recover from it."