Higher Risk Hearts?

"What is hypertension today for a fairly young black man of 35," says Dr. Charlene Dewey, "could be end-stage heart disease, stroke or a heart attack by the time he's 60." Dr. Dewey, assistant professor of medicine at Baylor College of Medicine, sees patients in the internal medicine clinic at Ben Taub General Hospital where she is associate director.

Dr. Charlene Dewey and patient Wilson Jones.

"When we see a man - or woman, for that matter - with a blood pressure of 150/90, we're not so apt to 'let it ride' as was maybe the custom a decade or so ago," says Dr. Dewey. "We have different guidelines now, and the attitude is 'OK, now I'm going to work with this patient until his pressure is 130/80.'"

According to the American Heart Association (AHA), 71 percent of black males aged 60 years or older have high blood pressure; blacks develop hypertension earlier in life and, at any decade of life, hypertension is more severe in black men than in whites. And high blood pressure can be a real killer: black men have a death rate which is attributable to high blood pressure that is 361 percent higher than whites; black women have a rate 371 percent higher than white women.

"We are seeing our aging patients more regularly," says Dr. Dewey. "They're more aware of coming in for their check-ups. But the younger people - probably because they're feeling well and showing no symptoms - still aren't coming for regular health maintenance. Unfortunately, many young people do not have contact with a health care provider for years at a time, which means they can have untreated hypertension."

The statistics (most recently available from the AHA) are startling: Black men have a death rate from cardiovascular disease of 343 (per 100,000), 47 percent higher than white males; black women, at 223 cardiovascular-related deaths per 100,000, have a rate 69 percent higher than white women. For stroke, black males have a rate 94 percent greater than white males, and black women have a rate 76 percent greater than white women.

What can explain these statistics?

Preventable risk factors may offer some - but not all - answers.

Thirty-four percent of black men and 22 percent of black women are smokers, about the same as for white men and women.

The rate of obesity has increased alarmingly for all ethnic groups. In just 30 years, the percent of the population (ages 20-74) considered overweight has risen from 23 percent to 32 percent for white males; from 22 percent to 32 percent for black males; from 24 percent to 34 percent for white females; and from 42 percent to 50 percent for black females. Another recent AHA study indicates that 63 percent of black men and 68 percent of black women lead sedentary lifestyles. Almost more troubling, 21 percent of black males ages 12-21 and 38 percent of black females the same age reported no moderate exercise in the previous seven days.

Blood cholesterol levels appear much increased in black women, compared to black men (ages 55-64, but significant in all age groups), 48 percent vs. 28 percent with cholesterol of 240 mg/dL or more.

"These statistics are troubling for another reason," says Dr. Dewey. "The increased risk of diabetes, which in turn is a very dangerous risk factor itself for cardiovascular disease. Men and women with diabetes have twice the likelihood of a heart attack or stroke, and they are more likely to die from a heart attack. And diabetics have a much higher rate of hypertension, lipid problems and, of course, renal disease."

But Dr. Dewey is optimistic. "The good news is that there has been so much public education and public awareness for women about their health. They are coming in regularly for their breast exams, pelvic exams, pap smears, and at that time they'll get their blood pressure checked. So we need to concentrate on getting the young men to start coming in for their regular health exams."

Stress is often cited as a risk factor for heart disease. Dr. Dewey is asked about the likelihood of chronic stress as a factor in the health of young urban black males.

"We're concerned about this of course, but it's so difficult to measure stress over a period of time.

"Much of the research literature seems to indicate that socio-economic factors outweigh the race differences in many diseases," says Dr. Dewey. "Whites, blacks, Hispanics and Asians from low socio-economic standing will have higher incidences of many diseases, from childhood through their senior years."

- ROGER WIDMEYER

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©2006 Texas Medical Center

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