How Race and Ethnicity Impact Heart Disease

How do race and ethnicity play a role in cardiovascular disease?

Cardiovascular disease is the leading cause of death for all adults. But it hits some people, especially minority groups, harder than others. For example, 47% of Black adults have been diagnosed with cardiovascular disease, compared with 36% of white adults.

When it comes to heart disease risk factors, minority groups also carry a heavier burden. Hispanic women are more than twice as likely as white women to have diabetes, which is a major risk factor for heart disease. And American Indians are three times more likely than whites to have diabetes.

Health disparities

These differences between racial and ethnic groups are called health disparities. Health disparities are a complex and challenging problem in the U.S. and around the world.

Researchers view race and ethnicity as social constructs rather than biological traits. In other words, the health differences between racial and ethnic groups aren’t caused by genetics. Social factors play the biggest role in shaping people’s health.

Many social factors affect a person’s health. Some important factors include a person’s ability to access:

• Money and resources for life’s basic needs.
• Quality education.
• Quality healthcare.
• A safe living environment (for example, clean air and water).
• Resources like nutritious food and fresh fruits and vegetables.
• Supportive relationships free of discrimination or violence.

These factors, known as “social determinants of health,” connect with each other. For example, poverty might prevent someone from following a heart-healthy diet. And if that person lives in a “food desert” with no healthy options for food, their choices are even more limited.

Social factors put Black, Hispanic and American Indian people at a disadvantage. These groups often carry a heavier economic and social burden. As a result, their health is also harmed. Other groups also face disadvantages that affect their risks for heart disease.

How do cardiovascular disease risks vary by race and ethnicity?

In the U.S., certain racial and ethnic groups are hit harder by high blood pressure (hypertension) and type 2 diabetes. These are two major risk factors for heart disease.

High blood pressure (hypertension)

• 59% of Black adults have hypertension. This is the highest prevalence among all racial and ethnic groups.
• 4 out of 5 Asian adults undergoing treatment still deal with unmanaged hypertension. This number lowers just a bit for Hispanic adults and Black adults (3 out of 4 for each group).
• Black women are twice as likely as white women to develop chronic hypertension during pregnancy. This condition raises a person’s risk for cardiovascular disease down the road.
• Black adults are more likely than white adults to have organ damage caused by hypertension. As a result, they’re four times more likely to experience end-stage kidney disease.
• Black adults are more likely than white adults to die from hypertension and related diseases.

Social factors impact these numbers. For example, people who lack insurance are more likely to have unmanaged hypertension. And people who face discrimination have higher blood pressure.

Hypertension can lead to complications including:

• Coronary artery disease.
• Heart failure.
• Stroke.
• Peripheral artery disease.
• Abdominal aortic aneurysm.
• Chronic and end-stage kidney (renal) disease.
• Dementia.

Type 2 diabetes

Type 2 diabetes can harm blood vessels in your heart, brain and kidneys. This condition also causes your triglyceride and LDL cholesterol levels to go up. People who have diabetes are twice as likely as those without it to have a heart attack or stroke.

About 1 in 10 people in the U.S. have some form of diabetes, and the vast majority (90% to 95%) have type 2 diabetes. Diabetes is a major health crisis for all people. But it affects some racial and ethnic groups more often.

Some researchers identify diabetes as an “exemplar health disparities disease.” In other words, differences among racial and ethnic groups are obvious in the data. And social factors cause them. Some racial and ethnic differences in diabetes prevalence include:

• Among American Indians, 1 in 4 adults have diabetes, compared with about 1 in 12 whites.
• Hispanic/Latinx, Black and Asian American adults are all more likely than white adults to develop diabetes.
• Black people are younger than white people when diagnosed with diabetes. As a result, they have a lower life expectancy.
• Hispanic/Latinx people are twice as likely as white people to have undiagnosed diabetes. That’s because they don’t always have health insurance and routine healthcare.
• Hispanic women are more than twice as likely as white women to have diabetes.
• Type 2 diabetes usually affects adults over age 45. But research shows it’s becoming more common among young adults and even children.
• Hispanic/Latinx children and Black children had the sharpest rise in diagnoses 2002 to 2015.
• Obesity raises a person’s risk of developing type 2 diabetes. Obesity is increasingly causing diabetes among Asian American, Black and Hispanic/Latinx people. Black adults have the highest prevalence of severe obesity (a BMI of at least 40).

Which ethnic group has the highest rate of heart disease?

Rates of heart disease vary depending on the specific diagnosis. Here are some key research findings from the U.S.

Heart failure

• Black men have a 70% higher risk of heart failure compared with white men.
• Black women have a 50% higher risk of heart failure compared with white women.
• Black adults are more than twice as likely as white adults to be hospitalized for heart failure. They also spend longer in the hospital and are more likely to be admitted again within 90 days.
• Hispanic adults are more likely than white adults to have heart failure.

Coronary artery disease and heart attack

• Black women are more likely than white women to have a heart attack.
• Black adults are more likely than white adults to die from a heart attack.
• Asian adults are less likely than other groups to have coronary artery disease. But there are some differences by ethnicity. Asian Indian men, Filipino men and Filipino women have a higher risk compared with white people.
• Young Hispanic women who have a heart attack face a higher risk of dying compared with young Hispanic men. They’re also more likely to die compared with young Black adults and young white adults.

Stroke

• Black adults are most likely to have a stroke compared with other racial and ethnic groups. They’re also likely to be younger.
• Black adults are more likely to die from a stroke compared with white adults.
• Mexican American adults are more likely than white adults to have a stroke.
• One study showed Filipino women are twice as likely as white women to have a stroke. Vietnamese men and Korean women are more likely than their white counterparts to have a hemorrhagic stroke.
• Filipino adults, Japanese men and Vietnamese men are more likely than white adults to die from a stroke.

A note from Cleveland Clinic

Cardiovascular disease is the leading cause of death in the U.S. But some people face higher risks than others. If you belong to a racial or ethnic group that faces health disparities, talk with your healthcare provider about your risks. If you don’t have a routine provider, look for community organizations and local resources that can help connect you to one.

It’s important to start young with checkups. Get your blood pressure, cholesterol and blood sugar numbers. Talk with your provider about what these numbers mean. Also talk about any family members who had heart disease risk factors or diagnoses. This information will help you and your provider work together to lower your risks.

People who don’t face health disparities can help improve the situation for those who do. Look for local organizations that support health equity. And work with your provider to identify your own personal risks and find ways to reduce them.