Monday, December 11, 2000

Taking Cardiovascular Health to Heart

Taking Cardiovascular Health to Heart
Pamela Appea
Originally published December 2000

Robert Tools who lived 151 days with a fully implanted artificial heart before dying November 30, became America’s most famous cardiovascular patient. While the five months he survived with the implant provided hope that modern medicine may yet conquer heart disease, his death was a reminder that the illness is still the number-one killer in the United States. More than just a test case for new medical technologies, Tools could also serve as an example of the importance of preventing heart disease, especially for African Americans.

No one enjoys thinking they could be at risk for heart disease but we all are—especially those of us who smoke, maintain a high-fat diet or consistently have high blood pressure readings. While heart disease is the leading cause of death for all Americans, the mortality rate for African Americans is much higher than for other groups, health experts say. And, as has been recently publicized, some heart medications may work less well in people of African descent. All the more important then, for African Americans to work on preventing heart disease, many of whose risk factors can be controlled by making lifestyle choices.

The black community, however, has not gotten the message. According to the Atlanta-based American Association of Black Cardiologists’ 2000 annual report: “Most African American men and women are more afraid of cancer, AIDS, and violence than CVD (cardiovascular disease, which includes disease of the heart and blood vessels), even though CVD is responsible for more deaths in the black community than all other diseases combined.”

Heart disease is often a “silent killer,” said Dr. De Vaughan Belton, a Washington, DC cardiologist. Belton noted that it can take years before heart disease causes life-threatening events such as heart attacks or strokes. In his practice, Belton said that when his patients—who are typically in their 50s and 60s—come in for appointments, he sometimes finds their 30-something children may be at significant risk for heart disease themselves.

“They feel perfectly healthy,” Belton said. “When you’re in your 30s, you’re invincible.” Younger people, cardiologists say, need to understand that the smoking, eating and exercise habits they practice now will have an enormous impact on their chances of developing heart disease later in life.

Heart Disease takes a social as well as individual toll. According to Dr. Lance Becker, director of the Emergency Resuscitation Center at the University of Chicago, cardiac arrest causes 1,000 deaths a day. “That’s the equivalent of two jumbo jets crashing every day in the US,” Becker said at an American Medical Association talk. According to the American Heart Association, if you add deaths by stroke, congestive heart failure and other associated cardiovascular ailments, the daily death toll is more than 2,600.

Why are so many people dying of a largely preventable disease? And why are so many African Americans at increased risk for both getting it and dying of it?

One reason is that most people, of all backgrounds, fail to report their symptoms and get help. Cardiologists say that many ignore symptoms because they don’t seem significant, and many don’t educate themselves.

“We need to educate, educate, educate,” said Dr. Hilton Hudson II a cardiac surgeon and the vice-chairman and vice-chairman of cardiothoracic surgery at Rockford Health Systems in Rockford, Illinois.

A strong advocate of education and living a healthy lifestyle, Hudson says African Americans owe it to themselves to learn more about heart disease. “We choose to know what the latest CD is; we know about black history,” he said. “Now, we need to know about heart disease and other issues that affect us.”

In The Heart of the Matter: The African American’s Guide to Heart Disease, Heart Treatment and Heart Wellness, Hudson tells the story of Reverent Asa Johnson, a 69-year-old Midwestern community leader who dropped dead of a heart attack during a church meeting.

Johnson, who had never been a drinker or a smoker, had ignored clear symptoms of heart disease for months, if not years. By not asking for help and ignoring shortness of breath and frequent heaviness in the middle of his chest, Johnson missed the chance to have his heart disease diagnosed and treated, possibly adding years to his life.

Hudson said that only 33 percent of African Americans who suffer signs of cardiovascular disease will connect the symptoms to heart disease, whereas 50 percent of the white population will make that connection. “ A lot of this is how we take care and don’t take care of ourselves,” Hudson said. “We must take control of our lives. Every day hundreds of African Americans die because they ignore these signs.”

According to Dr. Belton, many black patients, once diagnosed, discontinue their medication against medical advice. “They go home, they feel better they stop taking the drugs,” Belton said. One reason is financial—heart medications are expensive. But continuing the medication regime is essential, Belton said. Also, he said, black patients must make a point of talking to their doctors if they feel their medication is not effective—but let go of the fear that the medication won’t work for them.

Instead, advocacy groups like the Association of Black Cardiologists urge blacks to get involved in clinical research trials. Many times the sample of African Americans in test
groups is so small that researchers can’t determine the effectiveness of medications for African Americans as a group.

Hudson agrees that more black participation is needed in research trials, but says he understands why many African Americans are wary of studies. “Blacks have Tuskegee [the notorious syphilis experiment] on their minds. They don’t want to be guinea pigs,” he said. To combat this image, Hudson said doctors must break down the medical language barrier. He urges doctors to stress the advantages of research to their patients, but to be very truthful if they know of any possible side effects.

Belton, also a member of the Association of Black Cardiologists, added that it’s important for patients to write down all their questions and bring them to the doctor’s office. If patients and doctors can openly discuss symptoms, medications and options for healthier living, Belton says, there’s no reason why black people can’t live into their 80s—cardiovascular disease, he says, should not cut anyone’s life short.

It’s a theme echoed by the website of the Association of Black Cardiologists, where their motto reads: Children should know their grandparents.”

Are you at Risk?
According to the American Heart Association, the following factors can increase your risk of cardiovascular disease:
High Cholesterol
High Blood Pressure
Physical Inactivity

The best gift you can give yourself and your loved ones this holiday season is to visit your doctor to have your blood pressure and cholesterol levels checked and to talk about ways to increase your cardiovascular health.