It’s an unfortunate fact: Heart disease is not an equal opportunity disease. Nearly half of all African American adults have some form of cardiovascular disease, compared with just a third of all white adults in the U.S. And African Americans are 30 percent more likely to die from heart disease than non-Hispanic whites.
Yet, until recently, little research has probed the physiological factors that might explain racial differences in cardiovascular health. Although some researchers believe that a genetic difference that predisposes blacks to high blood pressure—a leading heart disease risk factor—might play a role in the disparity, new data suggests that’s not the whole story.
University of Pittsburgh researchers sought to shed greater light on heart disease risk in African American women. They studied the medical records, blood samples, and heart CT scans, which reveal coronary artery calcification—a key predictor of risk for heart attack—of 372 women. The women averaged 51 years of age, 130 were black, 242 were white, and none were on hormone replacement therapy, which could increase their cardiovascular risk, and none had a history of heart disease. Researchers then looked at levels of five biomarkers linked to inflammation and found that all of them were associated with the presence of coronary artery calcification. Coronary artery calcium scoring is used to determine the presence of heart disease, and higher scores indicate not only the presence of heart disease but the severity of heart disease.
After taking into account women’s body mass index (BMI), researchers discovered that obesity appeared to be the link between the inflammation markers and coronary artery calcification. Crucially, black women with higher levels of the inflammation marker, C-reactive protein (CRP), were more likely to exhibit calcification in the coronary arteries and had more calcification (i.e., higher scores) than whites, regardless of their BMI. What’s more, black women had double the levels of CRP as their white counterparts on average.
The study is not the only research suggesting potentially greater levels of inflammation in African Americans. Research in the journal Obesity showed that African-American women had higher levels of CRP and interleukin-6 (IL-6), another marker of inflammation, than white women and higher levels of fibrinogen, a protein that helps blood clot—thereby increasing cardiovascular risk—than both Hispanic and white women.
In a 2014 study in the International Journal of Obesity, researchers compared levels of inflammation markers among whites and several races and ethnicities. They found that CRP and IL-6 were significantly higher in African American men and women and suggested that African Americans may be “more prone to a state of inflammation given similar BMI levels and more likely to develop chronic conditions associated with inflammation.”
Although cholesterol testing and treatment have been among the most effective ways to reduce heart disease risk in the U.S., standard cholesterol screening doesn’t pick up a significant proportion of people at high risk for cardiovascular problems. Given the greater incidence and death rates due to heart disease among African Americans, inflammation bears a closer look.
While more research is needed to delineate the connection and identify other factors at play in heart risk, African Americans and their doctors may do well to consider the role inflammation is playing in their health and adopt proven strategies to calm it, from a healthy amount of physical activity and dietary changes to smoking cessation—strategies available to all people. Some may also need dietary supplements or medications in order to avoid a cardiovascular event.