Why Are Young Black Women at High Risk for Cardiovascular Disease?

Abstract

eart 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.2 These 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.4 Further 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

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