The U.S. kicked off its 60th annual American Heart Month with the sobering news that Black women who have high blood pressure by age 35 face up to triple the risk of a stroke by the time they reach middle age compared with their peers without hypertension. What’s more, Black women already have nearly double the risk of stroke as white women, and are 50% more likely to have high blood pressure.
As a Black female physician, I have grown tired of reading report after report and study after study revealing that certain groups of people — in many cases people who look like me — have worse health outcomes than their white counterparts. The status quo has not been acceptable for a long time, and yet, through our inability to improve outcomes, we are signaling that we accept it.
Each February, it is hard to escape the media’s broadcasting of disparities in cardiovascular disease outcomes on morning news networks, podcasts, and in newspapers. Don’t get me wrong, it’s important to acknowledge poor outcomes and new research that highlights another disparity, but it’s not enough to simply state these statistics. We also need to discuss and implement new and innovative strategies to decrease the impact of cardiovascular disease in America.
Let’s start with primordial prevention. Traditionally in cardiology we think about prevention in three different categories: prevention of heart disease in people with risk factors (primary prevention), prevention of further heart attacks and strokes in people who have had them (secondary prevention), and prevention of death or quality-of-life decline from heart attacks and strokes (tertiary prevention).
Primordial prevention is different. It focuses on preventing people from obtaining risk factors for heart disease (high blood pressure, diabetes, high cholesterol, physical inactivity) in the first place.
Atherosclerotic cardiovascular disease is the major cause of cardiovascular disease, and it includes diseases where plaque builds up in the artery, causing poor blood flow to parts of the body such as the heart (heart attacks), brain (strokes), and legs (peripheral artery disease).
We need to stress the point that even though controlling risk factors is great, to be the most effective we should put the emphasis on preventing risk factors for heart disease. Case in point: Research has shown that even when people with high blood pressure were treated with medication that lowered their risk of future heart disease, they still had two times higher risk of developing heart disease than people who were never diagnosed with high blood pressure to begin with.
We need to reach people at a young age before they are diagnosed with diabetes, high blood pressure, and high cholesterol. I’m not proposing not treating people who have or are at high risk for developing cardiovascular disease — as a cardiology physician, it is my mission to care for people impacted by heart disease. Rather, I’m saying cardiovascular disease is the number one cause of death in the U.S., and we need to do a better job at preventing people from getting risk factors for cardiovascular disease in the first place.
Second, in order to have the biggest impact, we need to address the fact that our target audience is not even in the clinic. A 2019 Kaiser Family Foundation poll found that 45% of adults ages 19-29 don’t even have a primary care doctor.
Where are they? They are in the community. They are in grocery stores, gyms, places of worship, barbershops, college campuses, and online. Approximately 84% of people in that same demographic are on social media. We need to implement federally funded programs to screen for risk factors in the community, where these people are. It is very common to have high blood pressure, diabetes, and high cholesterol without symptoms. We can’t continue to only screen people who encounter the health system. We know too much to continue to do so little.
Finally, once strategies are identified and implemented, we need policy to keep stakeholders accountable and funded. In order to make an impact, we need federal investment.
Not all communities are the same. Therefore, we need locally and regionally tailored screening strategies to target areas known to have the worst outcomes in heart disease. Let’s work with health departments and give them the financial support they need to screen for risk factors, and let’s hold them accountable for doing so.
Once individuals are given information, they can choose to make a change in their lifestyle or find a primary care doctor to help prevent risk factors from developing. Some may say that national prevention programs are costly. But so is our current healthcare system. We aren’t winning the fight against cardiovascular disease. We are losing it — along with the people we love.
If we truly honor the spirit of American Heart Month, I will spend my future years reading less about heartbreaking disparities affecting people who look like me and more about innovative strategies to prevent cardiovascular disease risk factors at a population level.
Nkiru Osude, MD, MS, is a cardiology fellow in the Duke division of cardiology in Durham, North Carolina. She is also a public voices fellow with the OpEd Project and AcademyHealth.
