Landmark Study Tracks Heart Disease in Blacks
Blacks in the United States are more likely than whites to die of heart disease--and at a younger age--and yet no one can say precisely why.
Although earlier diagnosis and improved treatment have contributed to an overall decline in U.S. death rates from cardiovascular illnesses during the past 30 years, blacks haven’t shared in those improvements. They continue to suffer high rates of potentially fatal cardiovascular diseases like hypertension and stroke. Black men are twice as likely as white men to die of heart disease before their 65th birthday.
Scientists have been aware of the growing problem of heart disease among black Americans for 30 years, but they have had little evidence to help explain the phenomenon and find better ways to target prevention and therapies.
Now researchers hope to fill that knowledge gap by embarking on the largest population study of this overlooked group. The $33-million project, sponsored by the National Institutes of Health, represents the federal government’s recognition of an “unchecked epidemic of cardiovascular disease in the African American population,” said Dr. Herman Taylor, director of the Jackson Heart Study.
The study is taking place in Mississippi, a state in which blacks die more often of heart disease than any place in the nation. Cardiac death rates for Mississippi blacks are higher than they were in 1980.
Most of what scientists know about the cardiac risk factors of smoking, high blood pressure, high cholesterol and diabetes comes from the landmark Framingham Heart Study, an ongoing project that has tracked men and women living in Framingham, Mass., a predominantly white Boston suburb.
Begun in 1948, the Framingham study was a product of its times, when there was a perception “that African Americans were not as vulnerable to [heart disease] as the rest of the population,” Taylor said. Information from death certificates at the time seemed to bear out the belief that white men were the most frequent victims of heart attacks. Framingham researchers began their work 16 years before President Lyndon B. Johnson signed the Civil Rights Act, which sought to assure equal treatment for minorities.
As doctors’ knowledge of heart disease has grown in recent years, they’ve come to better understand the subtle differences associated with gender, race and nationality. Doctors now know, for instance, that women’s heart attack symptoms are different from men’s, and that people living in Japan have different rates of heart disease compared to Japanese living in Hawaii or the U.S. mainland.
In the 1970s, blacks began dying at a greater rate from heart attacks than whites. Yet despite warning signs of a burgeoning public health problem, no one undertook a large-scale study to pinpoint how blacks might be uniquely affected by race, culture, economic status and other factors. Before the launching of the Jackson study, Taylor, a Harvard-trained cardiologist, said that whenever he attended national meetings of black physicians there would be talk about the need for a “black Framingham.”
Doctors, he said, want to understand “the peculiar excess of risk that African Americans experience.” They suspected that diet, poor access to medical care and inadequate health insurance were contributing factors, but they also were interested in genetic underpinnings and environmental influences like stress and discrimination.
Eventually, the NIH’s National Heart, Lung and Blood Institute became the lead sponsor of the Jackson Heart Study, launched in 2000 at the University of Mississippi Medical Center and two predominantly black schools, Jackson State University and Tougaloo College.
So far, researchers have signed up 1,700 of the 6,500 African Americans between the ages of 35 and 84 they hope to recruit. Their goal is to tease apart how much each of the various risk factors contributes to coronary artery disease, heart attacks, congestive heart failure and strokes, and at the same time, train more African Americans for careers in minority health research.
While still expecting to reach their enrollment goals, the researchers note that they have had to overcome a great deal of reluctance among blacks to participate in clinical studies. Those feelings stem in large part from the Tuskegee scandal in Alabama, where from 1932 to 1972, poor black men suffering from syphilis were deceived by doctors and nurses who claimed to be treating them, but instead used them to chart the course of unchecked disease.
But the Jackson Heart Study is beginning to catch up with aggressive community outreach, said Sonja Fuqua, director of recruitment, who added that a big selling point is that participants “are getting $4,000 of free medical care.”
Dr. Malcolm P. Taylor, president of the Assn. of Black Cardiologists, suggested that racial bias was at play during the many years when prominent white doctors believed blacks “couldn’t get coronary artery disease.”
Even when it became clear that blacks were at higher risk than the majority of the population, doctors still were not being trained to recognize specific warning signs. That has since changed, he said, with aggressive education efforts by major organizations such as the American Heart Assn.
The lack of cardiac care for African Americans has its roots in many problems, including doctors’ ignorance, some discrimination, and a lot of fear and denial.
Tuskegee, contends 64-year-old Betty Jacobs-Gray of Los Angeles, is the main reason many blacks have wanted nothing to do with federal health studies. Yet, Jacobs-Gray, a semiretired registered nurse who was raised in Greenville, Miss., supports such studies but regrets that they’ve come too late to benefit people like her. She and an aunt suffer from heart disease, and a grandmother and uncle died of the disease.
“We all fall dead, just boom, the heart blows itself out,” said Jacobs-Gray, who has had two angioplasties for blocked coronary arteries. She believes that stress, culture, education and ignorance about the disease all play a part in the higher death rates among blacks.
Her physician, Dr. David Ciraulo, medical director of the cardiology department at Daniel Freeman Memorial Hospital in Inglewood, is hopeful that the Jackson Heart Study will not only reveal some of the causes of heart disease among blacks, but also help public health officials design programs to reduce coronary artery disease.
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Heart Disease Deaths
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