Approximately 60 million women in the United States, accounting for 44% of the population, live with some form of cardiovascular disease, commonly referred to as heart disease. Furthermore, heart disease is responsible for 1 in 5 deaths among women, with those from racial and ethnic minorities facing a higher risk.
While doctors typically consider ‘traditional’ risk factors like obesity, smoking, diabetes, and high cholesterol when assessing a patient’s heart disease risk, a new scientific statement from the American Heart Association (AHA), published in its journal Circulation, emphasizes the need for medical professionals to go beyond these factors when monitoring and treating heart disease in women, particularly those from underrepresented groups.
Dr. Heather M. Johnson, a preventive cardiologist at Boca Raton Regional Hospital (part of Baptist Health South Florida), who was not involved in the report, highlighted that Black women in the United States, including African American and Afro Caribbean individuals, have the highest rate of heart disease compared to other women.
The AHA researchers argue that ‘nontraditional’ socio-economic factors, such as discrimination and environmental factors, must be taken into account to reduce the disparity in heart disease treatment and survival rates between white individuals and racial and ethnic groups. These often-overlooked factors can significantly impact health risks, care, and outcomes.
Understanding both traditional and nontraditional risk factors is crucial for preventing heart disease and ensuring early diagnosis and treatment in women,” Johnson explained.
The Impact of Bias, Discrimination, and Racism on Health
In their statement, the researchers noted, “Behavioral and environmental factors and social determinants of health… disproportionately affect women of underrepresented races and ethnicities.” These factors contribute to a higher prevalence of cardiovascular disease (CVD) and significant challenges in diagnosing and treating cardiovascular conditions among these groups.
The AHA’s statement highlighted five key social determinants of health and their influence on heart disease:
Discrimination
The AHA noted that ethnic communities facing discriminatory barriers often experience high levels of stress, which can contribute to heart disease issues such as inflammation and hypertension. Research also indicates that minority groups may encounter racial bias and stereotyping from white healthcare providers, potentially leading to the dismissal of patient concerns or the provision of subpar care. This can be attributed to the activation of stereotypes influencing clinical judgment.
Dr. Deborah L. Crabbe, a professor of medicine at the Temple Heart and Vascular Institute at Lewis Katz School of Medicine, emphasized that perceptions of racially motivated or discriminatory actions can erode trust between patients and providers, potentially resulting in patients not following through with care recommendations or seeking care from other providers, thereby delaying treatment.
Language Barriers
Communication in the healthcare setting becomes challenging when doctors and patients do not share the same first language. Language barriers can reduce patient satisfaction with care, care quality, and safety. They can also hinder the doctor-patient relationship, impede patients from advocating for themselves, and limit the doctor’s understanding of the full complexity of a patient’s condition and life circumstances.
Environment
Environmental factors such as air pollution, long-term arsenic exposure, and exposure to cadmium and lead have been linked to cardiovascular disease. Studies show that minority groups are more likely to reside in areas with higher levels of air pollution and closer proximity to toxic waste and other hazards. Polluting industries, waste facilities, and sources of exposure like highways have historically been located in communities of color due to their relatively lower political and economic influence.
These factors illustrate the critical importance of considering nontraditional risk factors and social determinants of health when addressing heart disease in women, especially those from underrepresented racial and ethnic backgrounds. Understanding and addressing these factors can contribute to more effective prevention, diagnosis, and treatment of heart disease.
The Impact of Cultural Assimilation
While the AHA statement did not explicitly address how acculturation or assimilation to a different culture affects heart disease, Dr. Yu-Ming Ni, a cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center, emphasized that this is an important factor that is often overlooked in cardiovascular disease (CVD).
For example, older studies of Japanese individuals have shown that those who traveled to Hawaii and then to the continental U.S. had higher cardiovascular disease rates than their peers who remained in Japan.
Access to Healthcare
The AHA statement noted that social determinants of health experienced in youth, such as the inability to access healthcare or afford care, can affect heart health into adulthood and contribute to cardiovascular disease risk factors and outcomes.
Research indicates that Black, Hispanic, Asian-American, and Native individuals are less likely to have health insurance. However, healthcare access encompasses more than just insurance coverage. It also includes factors like geographic access to specific healthcare services.
As Dr. Deborah L. Crabbe pointed out, there is often a lack of high-quality healthcare facilities in neighborhoods historically inhabited by people of color. Additionally, other social burdens, such as poverty, can limit access to healthcare. Ethnic minority groups are generally more economically disadvantaged compared to white populations, which can prevent individuals from affording necessary medications, among other challenges.
Furthermore, daily stressors, such as caregiving responsibilities and the threat of eviction, can take precedence over seeking healthcare. In many cases, addressing these urgent life challenges may overshadow healthcare concerns, regardless of their accessibility.
What to Discuss with Your Doctor
If you believe you are at a higher risk of heart disease, it is crucial to communicate your concerns and potential risk factors with your doctor.
Dr. Ni emphasized that discussing these concerns with your doctor allows them to take a more proactive approach to screening. For instance, if there is a fear of higher risk due to environmental factors, doctors may opt for earlier testing of disease states without symptoms.
The specific tests and screenings can vary depending on the patient and their medical history. Dr. Johnson recommended that everyone should understand their individual risk for heart disease and undergo a preventive heart health evaluation. This evaluation involves a comprehensive discussion of both traditional and nontraditional risk factors for heart disease.
Dr. Johnson further mentioned that additional preventive screening tests may be considered, including:
Electrocardiogram (EKG or ECG)
- Coronary artery calcium scan (also known as a calcium score)
- Special cholesterol tests
- Support from Healthcare Professionals
The AHA researchers emphasized the importance of culturally sensitive, peer-led community and healthcare professional education as a necessary step in preventing cardiovascular disease (CVD).
Language barriers can be overcome by providing translators or using language apps like Google Translate. Studies have shown that utilizing such apps in healthcare settings can significantly enhance satisfaction for both doctors and patients.
Michele Horan stressed the need for healthcare providers to screen patients from minority groups in a culturally competent and sensitive manner. Identifying barriers and understanding their root causes is essential for effective care coordination that addresses the full range of patients’ needs.
Dr. Crabbe highlighted the importance of education for both healthcare professionals and patients. Healthcare organizations can offer training and education to their staff to raise awareness about the challenges faced by minorities and women in accessing healthcare. Additionally, patient education can help improve health literacy, leading to better patient acceptance of healthcare recommendations and greater compliance.