Why Are Young Black Women at High Risk for Cardiovascular Disease?
2019; Lippincott Williams & Wilkins; Volume: 139; Issue: 8 Linguagem: Inglês
10.1161/circulationaha.118.037689
ISSN1524-4539
AutoresJolaade Kalinowski, Jacquelyn Y. Taylor, Tanya M. Spruill,
Tópico(s)Cardiovascular Health and Risk Factors
ResumoHomeCirculationVol. 139, No. 8Why Are Young Black Women at High Risk for Cardiovascular Disease? Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBWhy Are Young Black Women at High Risk for Cardiovascular Disease? Jolaade Kalinowski, EdD, Jacquelyn Y. Taylor, PhD, PNP-BC, RN and Tanya M. Spruill, PhD Jolaade KalinowskiJolaade Kalinowski Jolaade Kalinowski, EdD, Department of Population Health, NYU School of Medicine, 180 Madison Ave, New York, NY 10016. Email E-mail Address: [email protected] Department of Population Health, New York University School of Medicine, New York, NY (J.K., T.M.S.). , Jacquelyn Y. TaylorJacquelyn Y. Taylor Rory Meyers College of Nursing, New York University, New York, NY (J.Y.T.). and Tanya M. SpruillTanya M. Spruill Department of Population Health, New York University School of Medicine, New York, NY (J.K., T.M.S.). Originally published19 Feb 2019https://doi.org/10.1161/CIRCULATIONAHA.118.037689Circulation. 2019;139:1003–1004Heart disease remains the leading cause of death among women in the United States. Significant racial and sex disparities in cardiovascular disease (CVD) persist, and the high risk among young and middle-aged black women, in particular, is becoming increasingly apparent. In comparison with white women, black women have more CVD risk factors, develop CVD earlier, and have higher CVD mortality rates.1 Furthermore, despite overall declines in CVD mortality rates over the past several decades, black women 35 to 54 years of age are experiencing a concerning slowing of annual declines in mortality.2These realities beg 2 critical questions. First, what is driving the worsening CVD trends in young black women? Second, what can we do about it? The answer to the first question is not entirely clear, although we know some of the likely explanations. Complex interactions between genetic and environmental factors contribute to CVD risk, and powerful social justice inequities are exacerbating these processes and contributing to disparities. There is no question about how we have arrived at this unfortunate reality. Throughout American history, black women have known the art of juggling all too well. From slavery to the present day, black women have remained the matriarchs and pillars of their families. Through the war on drugs and mass incarceration, black women have continued to uphold their responsibilities as caregivers, often caring for grandchildren and extended families, often on their own, while maintaining jobs and careers, marriages, and relationships among so many other things. The added burden of racial and sex discrimination and of socioeconomic adversity has contributed to a dangerous environmental exposure with effects that reach across generations: chronic stress.Epidemiological studies suggest that exposure to chronic stress increases CVD risk, and there is growing evidence that it contributes to CVD disparities.3 Blacks have higher exposure than whites to some chronic stressors, such as institutional and structural discrimination, that are significant barriers to employment and quality health care.3 Other sources of chronic stress that disproportionately affect black women include interpersonal discrimination, intimate partner violence, and parenting stress, among others. In addition to greater exposure, blacks may be more vulnerable to some of the stress-related behavioral and pathophysiological effects associated with CVD. For example, black women have poorer dietary and physical activity patterns than white women on average,1 and exposure to chronic stress may contribute to or exacerbate these behavioral risk factors. Recent findings from the InterGEN study (Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure) suggest that parenting stress alters DNA methylation in black women and may be one of the mechanisms by which stress exposure affects the risk of hypertension, a major CVD risk factor.4Further fueling disparities is the underestimation of CVD risk in young black women by providers and, in turn, the women themselves. Awareness of heart disease as a leading cause of death among women is lower in black versus white women, and younger women are less likely than older women to be aware of heart attack symptoms.5 Underestimation of CVD risk results in missed opportunities for primary prevention. In addition, women are less likely to identify symptoms as cardiac-related, and providers are less likely to diagnose and treat their symptoms appropriately.5 Many of the symptoms of heart attack often experienced by women (eg, fatigue, cold sweats, back pain) are also associated with stress, and given their high levels of stress and insufficient knowledge about CVD, black women may attribute heart attack symptoms to stress and fail to seek timely treatment. Poor recognition of risk and symptoms by both patients and providers may help to explain the slower declines in CVD mortality in young black women than in other demographic groups.Multilevel strategies will be needed to narrow these disparities. First, greater investment in research aimed at understanding sex and racial disparities in CVD is essential. Much of the published epidemiological research does not stratify by race, ethnicity, ancestry, and sex, and, to date, few studies have explored the factors contributing to CVD risk in young black women. More research specifically focusing on young black women, not just including them, is needed. The role of gene-environment interactions and epigenetic mechanisms involving chronic stress, in particular, warrants further study to better understand the predisposition to CVD risk factors including hypertension, obesity, and diabetes mellitus. Second, recognizing the contribution of chronic stress to CVD disparities and applying this knowledge to intervention research will inform the development of new primary and secondary CVD prevention strategies. Although many of the chronic stressors black women experience are difficult to modify at the individual level (eg, discrimination, low socioeconomic status), coping strategies can be improved, which may positively impact stress-related behavioral and physiological pathways that influence CVD outcomes. Third, it is important to improve the awareness of CVD risk among young black women and their providers. Public health campaigns designed to educate black women about their CVD risk factors and how to identify symptoms of cardiovascular events are urgently needed.Last but not least, investing in black women scientists is critical. Historical underrepresentation of women and minorities in clinical trials and insufficient training and funding opportunities to support black women scientists have fueled the lack of data in this population. Stress is ultimately a subjective experience, and the use of assessment tools that fail to consider cultural differences in how stress is experienced and reported may mask important findings. Are we asking the right questions, in the right ways? Black women scientists have a key role to play in developing culturally sensitive approaches to capturing the burden of chronic stress experienced by young black women and effective approaches to reducing it. By improving education about CVD risk and addressing chronic stress as a powerful, modifiable risk factor, we may begin to slow CVD mortality in this population and narrow racial and sex disparities in CVD. The time is now to address the underrepresentation of young black women in research, as both participants and investigators.Sources of FundingThis work was supported in part by the National Institutes of Health (T32HL129953 and R01NR013520) and by the American Heart Association Go Red For Women Research Network (16SFRN28850003).DisclosuresNone.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.https://www.ahajournals.org/journal/circJolaade Kalinowski, EdD, Department of Population Health, NYU School of Medicine, 180 Madison Ave, New York, NY 10016. Email jolaade.[email protected]orgReferences1. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2018 update: a report from the American Heart Association.Circulation. 2018; 137:e67–e492. doi: 10.1161/CIR.0000000000000558LinkGoogle Scholar2. Smilowitz NR, Maduro GA, Lobach IV, Chen Y, Reynolds HR. Adverse trends in ischemic heart disease mortality among young New Yorkers, particularly young black women.PLoS One. 2016; 11:e0149015. doi: 10.1371/journal.pone.0149015CrossrefMedlineGoogle Scholar3. American Psychological Association, APA Working Group on Stress and Health Disparities. Stress and health disparities report: contexts, mechanisms, and interventions among racial/ethnic minority and low-socioeconomic status populations.2017. http://www.apa.org/pi/health-disparities/resources/stress-report.aspx. Accessed August 20, 2018.Google Scholar4. Wright ML, Huang Y, Hui Q, Newhall K, Crusto C, Sun YV, Taylor JY. Parenting stress and DNA methylation among African Americans in the InterGEN Study.J Clin Transl Sci. 2017; 1:328–333. doi: 10.1017/cts.2018.3CrossrefMedlineGoogle Scholar5. McSweeney JC, Rosenfeld AG, Abel WM, Braun LT, Burke LE, Daugherty SL, Fletcher GF, Gulati M, Mehta LS, Pettey C, Reckelhoff JF; American Heart Association Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Hypertension, Council on Lifestyle and Cardiometabolic Health, and Council on Quality of Care and Outcomes Research. Preventing and experiencing ischemic heart disease as a woman: state of the science: a scientific statement from the American Heart Association.Circulation. 2016; 133:1302–1331. doi: 10.1161/CIR.0000000000000381LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByLuu J, Malhotra P, Cook-Wiens G, Pepine C, Handberg E, Reis S, Reichek N, Bittner V, Wei J, Kelsey S, Sailaja Marpuri R, Sopko G and Bairey Merz C (2023) Long-Term Adverse Outcomes in Black Women With Ischemia and No Obstructive Coronary Artery Disease: A Study of the WISE (Women's Ischemia Syndrome Evaluation) Cohort, Circulation, 147:7, (617-619), Online publication date: 14-Feb-2023. Harris L, Berry D and Cortés Y (2021) Psychosocial factors related to Cardiovascular Disease Risk in Young African American Women: a systematic review, Ethnicity & Health, 10.1080/13557858.2021.1990218, 27:8, (1806-1824), Online publication date: 17-Nov-2022. Mehta R and Khan S (2022) Leveraging the Metabolome: Translating Social Risk Into Biological Pathways, Circulation Research, 131:7, (616-619), Online publication date: 16-Sep-2022. Okoro O, Hillman L and Cernasev A (2021) Intersectional invisibility experiences of low-income African-American women in healthcare encounters, Ethnicity & Health, 10.1080/13557858.2021.1899138, 27:6, (1290-1309), Online publication date: 18-Aug-2022. Jacoby V and Sawaya G (2022) The Swinging Pendulum, Obstetrics & Gynecology, 10.1097/AOG.0000000000004776, 139:5, (721-723), Online publication date: 1-May-2022. Lumsden R, Goldstein K, Shephard-Banigan M, Kroll-Desrosiers A, Bean-Mayberry B, Farmer M and Mattocks K (2022) Racial Differences in Nontraditional Risk Factors Associated with Cardiovascular Conditions in Pregnancy Among U.S. Women Veterans, Journal of Women's Health, 10.1089/jwh.2021.0078, 31:5, (706-714), Online publication date: 1-May-2022. Johnson A, Urizar G, Nwabuzor J and Dinh P (2022) Racism, shame, and stress reactivity among young black women, Stress and Health, 10.1002/smi.3152 Kaur-Gill S (2022) The meanings of heart health among low-income Malay women in Singapore: narratives of food insecurity, caregiving stressors, and shame, Journal of Applied Communication Research, 10.1080/00909882.2022.2033298, 50:2, (111-128), Online publication date: 4-Mar-2022. Lumsden R and Pagidipati N (2022) Management of cardiovascular risk factors during pregnancy, Heart, 10.1136/heartjnl-2021-319606, (heartjnl-2021-319606) Spikes T, Isiadinso I, Mehta P, Dunbar S and Lundberg G (2022) Socioeconomic characteristics of African American women attending community blood pressure screenings, American Heart Journal Plus: Cardiology Research and Practice, 10.1016/j.ahjo.2022.100123, 13, (100123), Online publication date: 1-Jan-2022. Sinha A, Ning H, Ahmad F, Bancks M, Carnethon M, O'Brien M, Allen N, Wilkins J, Lloyd-Jones D and Khan S (2021) Association of fasting glucose with lifetime risk of incident heart failure: the Lifetime Risk Pooling Project, Cardiovascular Diabetology, 10.1186/s12933-021-01265-y, 20:1, Online publication date: 1-Dec-2021. Figueroa C, Luo T, Aguilera A and Lyles C (2021) The need for feminist intersectionality in digital health, The Lancet Digital Health, 10.1016/S2589-7500(21)00118-7, 3:8, (e526-e533), Online publication date: 1-Aug-2021. Cozier Y, Castro-Webb N, Hochberg N, Rosenberg L, Albert M, Palmer J and Laganà A (2021) Lower serum 25(OH)D levels associated with higher risk of COVID-19 infection in U.S. Black women, PLOS ONE, 10.1371/journal.pone.0255132, 16:7, (e0255132) Lewis T, Van Dyke M, Matthews K and Barinas-Mitchell E (2020) Race/Ethnicity, Cumulative Midlife Loss, and Carotid Atherosclerosis in Middle-Aged Women, American Journal of Epidemiology, 10.1093/aje/kwaa213, 190:4, (576-587), Online publication date: 6-Apr-2021. St‐Onge M, Aggarwal B, Allison M, Berger J, Castañeda S, Catov J, Hochman J, Hubel C, Jelic S, Kass D, Makarem N, Michos E, Mosca L, Ouyang P, Park C, Post W, Powers R, Reynolds H, Sears D, Shah S, Sharma K, Spruill T, Talavera G and Vaidya D (2021) Go Red for Women Strategically Focused Research Network: Summary of Findings and Network Outcomes, Journal of the American Heart Association, 10:5, Online publication date: 2-Mar-2021. Chinn J, Martin I and Redmond N (2021) Health Equity Among Black Women in the United States, Journal of Women's Health, 10.1089/jwh.2020.8868, 30:2, (212-219), Online publication date: 1-Feb-2021. February 19, 2019Vol 139, Issue 8 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.118.037689PMID: 30779648 Originally publishedFebruary 19, 2019 Keywordsrace factorscardiovascular diseasesgender biasepidemiologystress, psychologicalPDF download Advertisement SubjectsRace and EthnicityRisk FactorsSecondary PreventionSocial Determinants of HealthWomen, Sex, and Gender
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