Two recent studies found that while deaths from heart disease are declining overall in the United States, those living in rural areas are at higher risk of dying from heart disease, and that Black rural men hold the greatest risk for developing heart failure.
Another study is underway at Morehouse School of Medicine, to study a genetic risk factor that can lead to heart disease disparities in Black Americans.
Morehouse is partnering with Amgen, a biopharmaceutical company, and the Association of Black Cardiologists for the study.
Dr. Anekwe Onwuanyi, chief of Morehouse School of Medicine’s cardiology department and president of the national Association of Black Cardiologists, says that the studies are important because they are examining factors that contribute to heart disease, which could be a key to early prevention.
“I think we have to start with prevention,” he said. “We need to make sure that we have services available to focus on making sure that people have access to primary care.”
Onwuyani also said that health insurance policy should move from models that focus on treatment, to ones that focus on prevention as well.
Heart disease is the leading cause of death nationwide and here in Georgia. According to the Georgia Department of Public Health, the condition claims more than 22,000 lives each year in Georgia, and accounts for one out of every three deaths in state.
Compared to an overall rate of 184 heart disease deaths per 100,000 people in the U.S., Black Georgians die at a rate of 207 per 100,000 people, with white Georgians dying at a rate of 185 per 100,000 people.
Examining heart health inequities
The University of Georgia researchers earlier this year published a study in the Journal of the American Heart Association that found that social and economic factors that influence health are the driving force behind heart disease deaths.
Dr. Zhuo Chen, one of the study’s authors, says that public health practitioners have set the goal of eliminating all health disparities. But social and health policies must support this goal, he says.
Credit: Rebecca Ayer
Credit: Rebecca Ayer
Chen, a professor of of health policy and management at University of Georgia College of Public Health, says that the study looks at a range of conditions that contribute to disparities. For instance, he explained that if a person does not have stable housing, then it is less likely for them to adhere to a medication schedule or to access a primary care physician. All of these factors can lead to more severe conditions.
The findings of the study draw from 10 years of data from 2009 to 2018, complied by the Agency for Healthcare Research and Quality, one of the 12 agencies within the Department of Health and Human Services. The database is made up of federal and academic sources, including census data, that were used to examine social, economic, educational health care and physical infrastructure conditions in 3,142 selected counties: 1,166 urban and 1,976 rural.
The study showed a range of factors leading to heart health disparities, which allowed the authors to create suggestions for policymakers to these eliminate inequities.
Chen said policymakers in all parts of government should work together to erase health disparities. “We need to work with all sectors of society to address these challenges to our healthcare system,” he said.
An estimated 1.4 million people in Georgia do not have health insurance, and the state’s uninsured rate of 14% is third in the country behind Texas and Oklahoma.
“Given that we (Georgia) have not expanded Medicaid, I think for the low income population, these social determinants of health probably will be playing an even bigger role,” he said.
Genetics, Black people and heart disease
The Morehouse study underway now will examine the link between lipoprotein(a) and unfavorable cardiovascular outcomes, such as heart attack and stroke. Lipoprotein(a) is a type of bad cholesterol and high levels of lipoprotein(a) oftentimes run in families, especially for Black people. High levels of lipoprotein(a) can restrict blood flow to the heart, brain, kidneys and other parts of the body, and lead to clotting in bloods vessels resulting in blockages.
Researchers at Morehouse School of Medicine say that much of research conducted on lipoprotein(a) has focused on people of European descent, leaving knowledge gaps in how this risk factor affects other populations. Dr. Elizabeth Ofili, a professor of medicine at Morehouse School of Medicine, is the principal investigator of the study.
Credit: Morehouse School of Medicine
Credit: Morehouse School of Medicine
Ofili says that the study is different because it focuses on the patients most affected by the issue. There will be 5,000 Black Americans enrolled in the study across the country, 2,500 with heart disease and 2,500 without heart disease, with in-state sites in Carrolton, Columbus and Macon.
Ofili also explained that the pandemic worsened heart disease problems.
“We found that people were not keeping up with appointments and levels were going back up in terms of heart attacks and strokes,” she said. “By the time we were learning about all the devastation of COVID, the hospitals were jammed up patients. We discovered that people couldn’t get into the emergency room for heart problems.”
Local implications
Shana Scott, says that the studies reinforce the work that many organizations are trying to do in the metro Atlanta area and in rural Georgia. Scott is vice president of health for the America Heart Association of Metro Atlanta.
“There are systems, policies and processes in place that you just don’t have control over as an individual, but as a community we can do something,” she said. " When you look at elected officials, you are making a small change because they are going to be that person that you can put in office who would create some systems change.”
Through her work locally with the American Heart Association, Scott says that food insecurity, housing instability caused by COVID, a lack of walkable communities and access to transportation are factors that she is seeing drive heart disease disparities in the metro area.
“My challenge would be to our elected officials, that when organizations come to you and talk about allocation of dollars, really consider ways that you can allocate dollars to address the social determinants of health,” Scott said. “So that we get on the ground and do the work in the communities, so that we can see better quality of life for our residents and our future.”
More on Heart Disease
- Heart disease is the leading cause of death in the United States. According to the Centers for Disease Control and Prevention, a person dies every 34 seconds in the United States from cardiovascular disease.
- Adults in rural areas have a 19% greater risk of developing heart failure than adults in urban areas.
- Black Americans are 30% more likely to die from heart disease than white Americans and nearly half of Black Americans have been diagnosed with heart disease.
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