- Around 60 million women in the US have cardiovascular disease (CVD).
- Women from racial and ethnic minority groups are at greater risk of CVD death.
- A new American Heart Association (AHA) statement emphasizes that doctors must also consider social determinants of health when screening for CVD.
- These include factors such as discrimination, environment, and language barriers.
Additionally, 1 in 5 deaths among women stems from CVD — with those from racial and ethnic minorities at
‘Traditional’ contributing factors, such as obesity, smoking, diabetes, and high cholesterol, are frequently considered by doctors when assessing a patient’s CVD risk.
“In comparison to other women, Black women in the US (including African American and Afro Caribbean) have the highest rate of heart disease,” stated Dr. Heather M. Johnson,a preventive cardiologist at Boca Raton Regional Hospital, part of Baptist Health South Florida, who was not involved with the report.
The AHA researchers stated that “nontraditional”socio-economic factors — such as discrimination and environment — must be considered if the gap in CVD treatment and survival between whites and racial and ethnic groups is to be reduced.
Many of these are often overlooked but can significantly affect health risks, care, and outcomes.
“Understanding both traditional and nontraditional risk factors are important to prevent heart disease, but also to support the early diagnosis and treatment of heart disease in women,” Johnson told Healthline.
In the statement, the researchers said: “Behavioral and environmental factors and social determinants of health … disproportionately affect women of underrepresented races and ethnicities.”
“These factors result in a higher prevalence of CVD and significant challenges in the diagnosis and treatment of cardiovascular conditions,” they added.
Five social determinants of health were emphasized in the AHA’s statement. But what are they and how do they influence CVD?
The AHA noted that discriminatory barriers faced by ethnic communities lead to high levels of stress. This, in turn, contributes to CVD issues such as inflammation and hypertension.
“Studies show this is often due to the activation of stereotypes that influence clinical judgment,” said Heather Orom, PhD, associate professor of community health and health behavior at the University at Buffalo.
Furthermore, when actions are perceived as racially motivated or discriminatory, this can “put a wedge between provider and patient and create an environment of mistrust,” said Dr. Deborah L. Crabbe, a professor of medicine at the Temple Heart and Vascular Institute at Lewis Katz School of Medicine.
As a result, she told Healthline, “patients may not follow through with care recommendations and may even seek other providers, perhaps delaying care for their medical condition.”
Understanding medical terms and phrasing can be tricky enough for patients at the best of times. However, things are complicated further when the doctor and patient don’t share the same first language.
“Language barriers can reduce patients’ satisfaction with their care, care quality, and safety,” explained Orom.
Furthermore, she told Healthline, such barriers can hinder the doctor-patient relationship, prevent patients from advocating for themselves, and inhibit the doctor from understanding the full complexity of a patient’s condition and their life circumstances.
The AHA statement revealed that “environmental factors, such as air pollution, high long-term arsenic exposure, and cadmium and lead exposure, have been linked to CVD.”
“For decades, polluting industries, waste facilities, and other sources of exposure, such as highways systems, have been more likely to be placed in neighborhoods of color,” Orom revealed. “This stems from the fact these communities have had less political and economic clout.”
The AHA statement didn’t expressly state how acculturation or assimilation to a different culture can impact CVD.
However, “this is an important factor for CVD that often is missed,” stated Dr. Yu-Ming Ni, a cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center.
For instance, he shared with Healthline that older
It was noted in the AHA statement that “there is evidence that SDOH factors experienced in youth, such as … inability to access healthcare or inability to afford care, may affect heart health into adulthood and contribute to CVD risk factors and outcomes in adulthood.”
Research shows that Black, Hispanic, Asian-American, and Native individuals are less likely to have health insurance.
But healthcare access isn’t only about insurance, said Crabbe. For example, “[it also] includes geographic access to a particular health care service.”
Orom concurred, stating there is a typically “lack of high-quality healthcare facilities in neighborhoods where people of color have historically lived.”
Other social burdens can limit access, too. For example, United States Census Bureau data shows that ethnic minority groups are generally poorer compared to white populations. Poverty can prevent individuals from purchasing necessary medications, for example.
Finally, Michele Horan, a registered nurse and COO of Healthy Alliance, shared that other daily stressors — such as care responsibilities and the potential of eviction — can reduce the capacity of underserved communities to access healthcare.
“In most cases, these urgent situations are prioritized over one’s health and well-being,” Horan told Healthline. “Addressing life challenges, in my experience, will almost always surpass healthcare, accessible or not.”
If you think you’re at higher risk of CVD, it’s crucial to ensure your doctor is aware of your concerns and potential risk profile.
Ni said discussing with your doctor means “they can be more aggressive with screening.”
For example, “doctors might choose to test for disease states with no symptoms earlier than usual if the fear is that someone has a higher risk due to the environment they live in,” he explained.
Tests and screenings generally vary depending on the patient and their history.
It’s recommended that “everyone understands their individual risk for heart disease and has a preventive heart health evaluation,” Johnson said.
This assessment, she explained, “includes a detailed discussion of their traditional and nontraditional risk factors for heart disease.”
According to Johnson, further preventative screening tests are also possible and include:
- Electrocardiogram (EKG or ECG)
- Coronary artery calcium scan (also known as a calcium score)
- Special cholesterol tests
What can healthcare professionals do to help?
According to the AHA researchers, “culturally sensitive, peer-led community and healthcare professional education is a necessary step in CVD prevention.”
Language barriers can be overcome by providing translators or simply using language apps, such as Google Translate.
Horan said healthcare providers need to screen patients from minority groups in a culturally competent and sensitive way.
“Identifying barriers and the root cause behind them with a proactive lens is often the only way to effectively coordinate care in a manner that addresses their patient’s full spectrum of needs,” she asserted.
Education is vital for both medical professionals and patients, said Crabbe.
“Healthcare organizations can provide training and education to staff regarding the challenges that minorities and women face in receiving healthcare,” she noted.
Meanwhile, Crabbe continued, “opportunities to provide education to improve the health literacy of minorities and women could help improve patient acceptance of healthcare recommendations, and thus compliance.”