Link between racial discrimination and heart disease gaining acceptance

Georgia researchers say new evidence too compelling to ignore
Cardiovascular disease is the leading cause of death in the U.S. African Americans are significantly affected by heart disease, resulting in higher mortality rates compared to white Americans. (Dreamstime/TNS)

Credit: TNS

Credit: TNS

Cardiovascular disease is the leading cause of death in the U.S. African Americans are significantly affected by heart disease, resulting in higher mortality rates compared to white Americans. (Dreamstime/TNS)

For many years, psychologists Katherine Ehrlich of the University of Georgia and Negar Fani of Emory University separately studied how racism leads to disease in Black communities. Neither felt their research was recognized by the medical community — until recently. The change comes after increasing research into the connection between racism and health conditions, including heart disease, which disproportionately impact the Black community.

Heart disease is the leading cause of death in the country and about 1 in 3 die from the disease in the state, according to the Georgia Department of Public Health. Nearly 60% of Black adults have heart disease, and the death rate is higher for them than any other race or ethnic category, the American Heart Association reports.

Ehrlich, a UGA associate psychology professor, was principal investigator of a study published in April in the JAMA Network exploring how racial discrimination predisposes young Black adults to metabolic syndrome, which can increase risk for heart disease.

“The new evidence is pretty compelling,” Ehrlich said. “What we and others have seen is a concept called weathering. Marginalized people in the Black community experience socioeconomic stress, discrimination, and microaggressions that damages their body and exert changes at the cellular level.” This pattern can lead to chronic inflammation and over time, chronic disease, Ehrlich explained. “It does not happen overnight, but over time, behavioral and biological changes increase the risk for cardiovascular disease, stroke, diabetes, and even some cancers.”

The study, conducted between June 2009 and May 2021, included 322 participants living in some of the poorest counties in rural Georgia who reported discrimination between the ages of 19 and 21. More frequent exposure to discrimination was associated with a higher likelihood of metabolic syndrome when researchers measured it among participants at ages 25 and 31.

Ehrlich said she’s encouraged by acceptance and agreement in the medical community that experiences of discrimination impact health. “Over time, evidence becomes harder to ignore and discount.”

Her study joins a lengthy list of recent studies involving similar subjects. Last year, researchers from the University of Louisville’s School of Medicine reviewed 123 studies on racial discrimination as a risk factor for cardiometabolic diseases (CMD) such as heart disease. Black Americans were the most frequently studied group, according to the research published in the Journal of Racial and Ethnic Health Disparities. The focus on this population makes sense, according to the researchers, “given that African Americans are the largest U.S. racial minority group, the frequency of CMD in African Americans, as well as the extent of racial discrimination and health inequities.”

The Louisville study found an association between experiences of discrimination and CMD, with about 73% of studies reviewed reporting “significant links.” Previous reviews also suggest a significant connection between racial discrimination and cardiovascular health, the study found.

While poverty in underserved communities exerts health stressors, racial discrimination also impacts those who leave poorer rural areas, Ehrlich discovered in her research. The study participants began as 11-year-old disadvantaged adolescents from rural Georgia counties. Tracked for 20 years, many moved out of a largely Black community where they likely felt connected and protected, she said.

“We see in our sample and in other longitudinal studies those who become upwardly mobile end up experiencing more discrimination as they go to college and frequently find themselves in white spaces, have professional jobs where they are the only Black people, and move out of their [Black] community into more hostile environments.” Racism and other discriminatory stressors might include redlining and residential segregation, Ehrlich said. “They can be wealthy Americans and still encounter racism on a regular basis.”

Fani, an Emory associate professor of psychiatry and behavioral sciences, has studied the link between racism and brain changes that lead to increased disease risk in the Black community as part of the Grady Trauma Project. The study, which has been running for nearly 20 years, focuses on trauma and stress in Atlanta’s urban Black community, including racial discrimination. The majority of participants in the Grady project are Black women, some of whom have multiple health challenges, including heart disease, Fani said.

“A number of papers have linked racial discrimination to adverse health outcomes.” Research published in high-impact journals and with funding from the National Institutes of Health lends credibility to the contention, she said.

For instance, those who experience stress from discrimination might turn to overeating or drinking as a coping mechanism, Fani said. Obesity disproportionately impacts Black Americans, according to the Centers for Disease Control and Prevention in Atlanta.

Fani believes the medical community was long skeptical about racism-related physiological changes that can affect health outcomes. But they started to recognize the link between racist experiences and health disparities during the pandemic in 2020, which Fani attributes to three factors:

--Data from the CDC and other sources reporting Black patients were more likely than white patients to become sicker from COVID and be hospitalized.

--Greater understanding about racial inequity after George Floyd, a Black man, was killed by a white Minneapolis police officer who knelt on his neck until he died during an arrest.

--The revival and advancement of the Black Lives Matter movement.

Researchers also were able to statistically isolate the effects of racism from other factors, such as poverty, which might contribute to health conditions, Fani added. “It’s hard to ignore basic facts.”

While there’s been progress, Fani said Black patients often feel stress reporting their health conditions to medical professionals for fear their concerns won’t be validated. She suggested increased education for health care providers to recognize biases and how to avoid them.

Primary care doctors also could include questions about stress from racial discrimination as part of their initial health assessments, she said.

Along with Emory, Morehouse School of Medicine (MSM) has been studying the connections between the environment in which blacks in several Atlanta communities live and risk factors for cardiovascular health. A newer phase of the Morehouse-Emory Center for Health Equity Study is evaluating blood samples from study participants to determine how inflammation and other factors change when the body is exposed to different environments, said cardiologist Melvin Echols, a MSM associate professor of medicine and associate director of the Cardiovascular Research Institute who studies cardiovascular diseases and health disparities.

He said he’s seen an evolution of acceptance about racism’s impact on health disparities because of the plethora of research documenting the link. Previously, there wasn’t a clear way to measure the impact.

“People are more interested in racism’s effect on health, particularly heart health.” And it makes sense that adverse issues certain people face can lead to mental and physical health challenges, added Echols, who is also chief Health Equity & Diversity officer for the American College of Cardiology.

As more leaders educate and publicize the research, he hopes the scientific and medical community can eventually relay the information to their patients so they understand the interactions between discrimination and health disparity. But Echols admits it’s still early for the evidence to translate into policy change, such as improved transportation, access to health care and health literacy. “We are definitely heading in the right direction.”

By the Numbers

· About 1 in 3 die from heart disease in Georgia

· Nearly 60% of Black adults have heart disease

· Black Americans are 30% more likely to die from heart disease than white Americans

Sources: Georgia Department of Public Health, U.S. Department of Health and Human Services, American Heart Association