Table of ContentsView AllTable of ContentsDisparitiesRisk FactorsPreventionContributing FactorsNext Steps
Table of ContentsView All
View All
Table of Contents
Disparities
Risk Factors
Prevention
Contributing Factors
Next Steps
Cardiovascular disease(CVD), also known as heart disease, is the leading cause of death worldwide.CVD includes conditions such ashypertension,stroke,peripheral artery disease, and more.
Prevention is an important strategy to reduce death and suffering from CVD. It relies on managing risk factors and startingpreventive medicationsfor those with elevated risk. Yet, inequities exist in CVDrates, risk factors,treatment, and prevention.
This article discusses risk factors for CVD, health disparities, prevention strategies, and ways to advocate for treatment.
Jochen Tack / Getty Images
Disparities in Cardiovascular Disease
Heart disease does not affect all groups equally. Race and ethnicity, gender, geography, genetics, and socioeconomic status have all been associated with variable outcomes.
Communities that often experience barriers to care that lead to worse health outcomes include:
The reasons for this are complex, with many contributing factors.
Race and Ethnicity
Race and ethnicity are socially constructed labels based on ancestral and cultural characteristics. While some genetic factors are linked to ancestry, science makes it clear that race is not biological.
When considering how race and ethnicity relate to CVD, it’s important to note that many of the differences are not due to genetic predisposition, but to environmental conditions knownsocial determinants of health. These include things factors like:
While social determinants of health increase CVD rates through an increase of risk factors, they are not the only cause of racial disparities in CVD. Access to healthcare, biases within the healthcare community, and the ways bias within health care have broken community trust in the system also contribute.
Some examples of these outcomes include:
Gender
Gender discrepancies in CVD are also prevalent. CVD is the leading cause of death regardless of gender, but differences in diagnosis and treatment contribute to variable outcomes.
Geography
Within the United States, disparities also exist based on geography. These disparities can be regionally-based, or exist based on rural vs. urban environments. For example:
Socioeconomic Status
Socioeconomic status, which includes income, education, employment, and environmental factors, is a major driver of CVD incidence and outcomes.
Disparities in CVD Risk Factors
Health disparities also exist for individual CVD risk factors. Those belonging to groups that are widely discriminated against and socially stigmatized may be more likely to have a particular risk factor, be affected at a younger age, and diagnosed later in the course of disease.
High Blood Pressure
Hypertension, or high blood pressure, is one of the leading risk factors for CVD, and affects some groups more than others.
Diabetes
Diabetesis another common risk factor for CVD. Rates of diabetes and level of blood sugar control are worse in certain groups.
High Cholesterol
High cholesterolis a major CVD risk factor that affects groups unequally. Furthermore, some groups are less likely to receive appropriate therapies to control cholesterol numbers.
Smoking
People belonging to socially stigmatized groups and those with lower income, education, and socioeconomic status have higher tobacco-related risk.
Other Risk FactorsOther CVD risk factors with disparities in prevalence and treatment across minority groups and geographic location include:Chronic kidney diseaseExcessively overweightNutritionSedentary lifestyle
Other Risk Factors
Other CVD risk factors with disparities in prevalence and treatment across minority groups and geographic location include:Chronic kidney diseaseExcessively overweightNutritionSedentary lifestyle
Other CVD risk factors with disparities in prevalence and treatment across minority groups and geographic location include:
Disparities in CVD Prevention
To add to the inequities in CVD and its risk factors, prevention of CVD has its own share of problems. The following are just some of the issues that contribute.
Social determinants of health account for many of the disparities of CVD, risk factors, and prevention. They include the following:
In addition, systemic factors, such as biases within the healthcare system, contribute to inequalities. For example, many clinical studies were done on White men, leaving out Black, Brown, and gender oppressed people.
Further, members of some socially stigmatized groups distrust the healthcare system. This is in part due to historic and current racist, sexist, cisgender normative, and heteronormative practices.
The Tuskegee Syphilis StudyOne example of historic racism in medicine is the unethical Tuskegeesyphilisstudy that took place in 1932. In the study, Black patients were deliberately not treated for syphilis in order to study its long-term effects.There are many other studies that suggest ongoing racism and biases in medical practice, with certain groups receiving less effective care.
The Tuskegee Syphilis Study
One example of historic racism in medicine is the unethical Tuskegeesyphilisstudy that took place in 1932. In the study, Black patients were deliberately not treated for syphilis in order to study its long-term effects.There are many other studies that suggest ongoing racism and biases in medical practice, with certain groups receiving less effective care.
What Can Be Done?
While advancements in treatment and prevention of CVD have come a long way in the last several decades, it’s disheartening that such significant disparities still exist. Fortunately, the scientific community is more aware of health disparities. More research is being done on this topic, with goals being set to improve healthcare equity.
While large-scale change is needed to improve health equity, it’s also important that each individual is empowered to be an advocate for their own health.
The first step of CVD prevention is awareness of increased risk. Next steps involve specific actions, which can include personalized lifestyle changes, understanding the role of prescribed medication, and conversations with the healthcare team.
How to Be a Better Health Advocate for Yourself
Lifestyle Factors
Other modifiable risk factors can be improved with both individual behaviors and medical therapy, like diabetes, high blood pressure, and high cholesterol.
For modifiable risk factors, some measures can be taken to help reduce a person’s risk of developing CVD:
Medications
After lifestyle changes, the cornerstone of CVD prevention is statin therapy.
Guidelines from the American College of Cardiology and the American Heart Association recommend calculating a risk score, called ASCVD Risk Estimator, which assigns a 10-year and lifetime risk of ASCVD.
When risk is high, a statin is indicated. Those with borderline or intermediate risk may benefit from a statin, depending on other factors.
What Are Statins?Statinsare drugs that improve cholesterol and have anti-inflammatory effects. Many studies have proven the profound benefit of statins for preventing heart attacks, strokes, and death from CVD.
What Are Statins?
Statinsare drugs that improve cholesterol and have anti-inflammatory effects. Many studies have proven the profound benefit of statins for preventing heart attacks, strokes, and death from CVD.
The following are steps that individuals can consider taking in order to play an active role in prevention of heart disease and stroke:
Summary
While cardiovascular disease can affect anyone, health disparities contribute to higher incidence and worse outcomes for certain groups. This is in part due to differences in CVD risk factors and prevention.
Social determinants of health are responsible for many of these inequalities. Continued research to understand these risk factors, as well as societal and institutional commitment, are necessary to achieve health equity in CVD prevention.
A Word From Verywell
Because of health inequities, it’s important to be an advocate for your health. It’s also important to play an active role in CVD prevention in areas that you can control. Understanding and following treatment plans for CVD and its prevention are essential. Never feel afraid or embarrassed to ask a healthcare provider questions, and speak up if you are having any issues getting or taking medications.
37 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
World Health Organization.Cardiovascular diseases.
Mazimba S, Peterson PN.JAHA spotlight on racial and ethnic disparities in cardiovascular disease.J Am Heart Assoc. 2021;10(17):e023650. doi:10.1161/JAHA.121.023650
U.S. Department of Health and Human Services: Healthy People 2030.Social determinants of health.
Centers for Disease Control and Prevention.Health, United States spotlight: racial and ethnic disparities in heart disease.
Hackler EL 3rd, Hamburg NM, White Solaru KT.Racial and ethnic disparities in peripheral artery disease.Circ Res. 2021;128(12):1913-1926. doi:10.1161/CIRCRESAHA.121.318243
Arya S, Binney Z, Khakharia A, et al.Race and socioeconomic status independently affect risk of major amputation in peripheral artery disease.J Am Heart Assoc.2018;7(2). doi:10.1161/JAHA.117.007425
Cruz-Flores S.Racial and ethnic disparities in stroke care.Stroke. 2019;50(9):2288-2289. doi:10.1161/STROKEAHA.119.026208
Volgman AS, Palaniappan LS, Aggarwal NT, et al.Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association.Circulation.2018;138(1). doi:10.1161/CIR.0000000000000580
Wilmot KA, O’Flaherty M, Capewell S, Ford ES, Vaccarino V.Coronary heart disease mortality declines in the United States from 1979 through 2011: evidence for stagnation in young adults, especially women.Circulation. 2015;132(11):997-1002. doi:10.1161/CIRCULATIONAHA.115.015293
Lewis JF, Zeger SL, Li X, et al.Gender differences in the quality of EMS care nationwide for chest pain and out-of-hospital cardiac arrest.Womens Health Issues. 2019;29(2):116-124. doi:10.1016/j.whi.2018.10.007
Smolina K, Ball L, Humphries KH, Khan N, Morgan SG.Sex disparities in post-acute myocardial infarction pharmacologic treatment initiation and adherence: problem for young women.Circ Cardiovasc Qual Outcomes. 2015;8(6):586-592. doi:10.1161/CIRCOUTCOMES.115.001987
Panza GA, Puhl RM, Taylor BA, Zaleski AL, Livingston J, Pescatello LS.Links between discrimination and cardiovascular health among socially stigmatized groups: A systematic review.PLoS One. 2019;14(6):e0217623. doi:10.1371/journal.pone.0217623
Caceres BA, Streed CG, Corliss HL, et al.Assessing and addressing cardiovascular health in LGBTQ adults: a scientific statement from the American Heart Association.Circulation. 2020;142(19). doi:10.1161/CIR.0000000000000914
Cross SH, Mehra MR, Bhatt DL, et al.Rural-urban differences in cardiovascular mortality in the US, 1999-2017.JAMA.2020;323(18):1852–1854. doi:10.1001/jama.2020.2047
Casper M, Kramer MR, Quick H, Schieb LJ, Vaughan AS, Greer S.Changes in the geographic patterns of heart disease mortality in the United States: 1973 to 2010.Circulation. 2016;133(12):1171-1180. doi:10.1161/CIRCULATIONAHA.115.018663
Schultz WM, Kelli HM, Lisko JC, et al.Socioeconomic status and cardiovascular outcomes: challenges and interventions.Circulation. 2018;137(20):2166-2178. doi:10.1161/CIRCULATIONAHA.117.029652
Centers for Disease Control and Prevention.Every heart counts.
American College of Cardiology.Racial disparities in hypertension prevalence and management: a crisis control?.
Shahu A, Herrin J, Dhruva S, et al.Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).J Am Heart Assoc.2019;8(15). doi:10.1161/JAHA.119.012277
Centers for Disease Control and Prevention.Facts about hypertension.
Centers for Disease Control and Prevention.Prevalence of diagnosed diabetes.
Centers for Disease Control and Prevention.National and state diabetes trends.
Makshood M, Post WS, Kanaya AM.Lipids in South Asians: epidemiology and management.Curr Cardiovasc Risk Rep. 2019;13(8):24. doi:10.1007/s12170-019-0618-9
Safford MM, Gamboa CM, Durant RW, et al.Race-sex differences in the management of hyperlipidemia: the Reasons for geographic and racial differences in stroke study.Am J Prev Med. 2015;48(5):520-527. doi:10.1016/j.amepre.2014.10.025
Centers for Disease Control and Prevention.Cigarette smoking and tobacco use among people of low socioeconomic status.
Prevent Cancer Foundation.Lesbian, gay, bisexual, and transgender persons and tobacco use.
Centers for Disease Control and Prevention.African Americans and tobacco use.
U.S. Department of Health and Human Services.Smoking cessation: a report of the Surgeon General.
Rodriguez F, Chung S, Blum MR, Coulet A, Basu S, Palaniappan LP.Atherosclerotic cardiovascular disease risk prediction in disaggregated asian and hispanic subgroups using electronic health records.JAHA. 2019;8(14). doi:10.1161/JAHA.118.011874
Dorsch MP, Lester CA, Ding Y, Joseph M, Brook RD.Effects of race on statin prescribing for primary prevention with high atherosclerotic cardiovascular disease risk in a large healthcare system.J Am Heart Assoc. 2019;8(22). doi:10.1161/JAHA.119.014709
Nanna MG, Wang TY, Xiang Q, et al.Sex differences in the use of statins in community practice: patient and provider assessment of lipid management registry.Circ: Cardiovascular Quality and Outcomes. 2019;12(8). doi:10.1161/CIRCOUTCOMES.118.005562
Centers for Disease Control and Prevention.The Tuskegee timeline.
American Heart Association.The American Heart Association’s 2024 goal.
American Heart Association.What is cardiac rehabilitation?.
Arnett DK, Blumenthal RS, Albert MA, et al.2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation. 2019;140:e563–e595. doi:10.1161/CIR.0000000000000678
Centers for Disease Control and Prevention: Million Hearts.The scoop on statins: what do you need to know?.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
