Cardiovascular risk factors appear early in Black women

Young Black women show a high prevalence of obesity, elevated blood pressure and other lifestyle-related factors that may put them on a trajectory to develop heart disease at a young age, according to a study presented at the American College of Cardiology's 70th Annual Scientific Session.

While previous research has drawn attention to the burden of heart disease among Black women, the new study is unique in its focus on examining the age at which heart disease risk factors emerge in this population in a community setting. The researchers found high rates of lifestyle-linked risk factors among Black women as early as their 20s and 30s.

"Young people should be the healthiest members of our population with normal body weight and normal blood pressure," said Nishant Vatsa, MD, an internal medicine resident at Emory University Hospital in Atlanta and the study's lead author. "We're finding obesity and elevated blood pressure are present in women even at younger ages, which is worrisome. Thus, interventions like educating young women about healthy dietary choices and the benefits of exercise, improving access to health care and enhancing the ability for people to adopt healthy practices—such as increasing access to healthy foods and safe areas for physical activity—needs to start early."

Vatsa and colleagues analyzed data collected in 2015-2018 from 945 Black women enrolled in a community health screening project in Atlanta. They assessed health markers such as body mass index (BMI), blood pressure and cholesterol levels; socioeconomic factors such as education, income and health insurance; and lifestyle factors such as smoking, diet and exercise.

The average BMI for women of all age groups was 30 or above, a level considered clinically obese. Systolic blood pressure levels, a measure of the force at which blood pushes against the artery walls during a heartbeat, increased with age. From ages 20-39 years, Black women had an average systolic blood pressure of 122 mmHg—higher than the 120 mmHg considered normal by the 2017 ACC/American Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Systolic blood pressures worsened in older age groups, where middle-aged and older women had an average systolic blood pressure of nearly 133 and 142, respectively.

Obesity and high blood pressure are key risk factors for heart disease. Both are known to be influenced by lifestyle factors such as diet and exercise. Nearly 1 out of 3 women aged 20-39 reported eating fast food at least three times per week and 2 out of 5 consumed more than the recommended amount of salt daily. These proportions were also high in middle-aged women but lower among those older than 60.

Based on the findings, Vatsa said there should be a call for increased attention among clinicians and the public health community to help young Black women maintain their weight and blood pressure within a healthier range through lifestyle changes and medications when warranted.

"Diet and exercise play a major role in blood pressure and weight," Vatsa said. "Primary care providers, prevention-based clinics and community organizations can facilitate interventions proven to mitigate these risk factors. Providers that treat young Black women need to be mindful of cardiovascular preventive care and be armed with resources and education."

He added that the coronavirus pandemic, which has disproportionately affected Black and other minority communities, has revealed and exacerbated the barriers Black women face in accessing preventive health care. Increased attention to reducing barriers in health care and to the adoption of a heart-healthy lifestyle can improve health in the near term and reduce the burden of heart disease for decades to come, he suggested.

The study analysis did not include participants younger than 20, and Vatsa said that some factors, such as obesity, may emerge even earlier. The study stems from the Emory Women's Heart Center 10,000 Women Hypertension project, which offers free cardiovascular risk screenings with a focus on African-American women. While the researchers believe the observed trends are likely reflective of the broader population of Black women, they plan to compare their findings with studies from other regions of the U.S. and other racial and ethnic groups for additional insights.