Higher levels of perceived racism linked to increased risk of heart disease in Black women

Research Highlight:

• A long-term study of more than 48,000 Black women assessed two measures of perceived interpersonal racism with risk of coronary heart disease.
• Experiencing self-reported interpersonal racism in employment, housing and interactions with the police was associated with a 26% higher risk of coronary heart disease, relative to not experiencing interpersonal racism in those areas.
• Self-reported experiences of racism in everyday life were not associated with an increased risk of coronary heart disease.

Embargoed until 3 p.m. CT/4 p.m. ET, Wednesday, March 1, 2023

DALLAS, March 1, 2023 — Self-reported interpersonal racism in employment, housing and interactions with the police was associated with a 26% higher risk of coronary heart disease among Black women, according to preliminary research presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023. The meeting will be held in Boston, February 28-March 3, 2023, and offers the latest science on population-based health and wellness and implications for lifestyle and cardiometabolic health.

“Many Black adults in the U.S. are already at higher risk of developing heart disease due to high blood pressure or Type 2 diabetes,” said Shanshan Sheehy, Sc.D., lead author of the study and an assistant professor at the Slone Epidemiology Center at Boston University and Boston University’s Chobanian & Avedisian School of Medicine. “Current evidence shows that racism may act as a chronic stressor in the human body, and chronic stress may lead to high blood pressure, which increases the risk of heart attack and stroke.”

Researchers evaluated data for approximately 48,000 individuals enrolled in the Black Women’s Health Study, the largest follow-up study on the health of Black women in the U.S. They reviewed data gathered from 1997, two years after the Black Women’s Health Study began, through 2019 to investigate whether self-perceived interpersonal racism was associated with an increased risk of coronary heart disease. In 1997, the age range of participants in the study was 22-72 years old and by 2019, the age range was 40-90 years old. All participants were free of cardiovascular disease and cancer in 1997; during the 22-year follow-up period, 1,947 women developed coronary heart disease.

In 1997, the participants answered five questions about their experiences related to interpersonal racism in their everyday activities, such as “How often do people act as if they think you are dishonest?” They also answered three questions (for a total of eight) that asked “have you ever been treated unfairly due to your race in any of the following circumstances?” — employment (hiring, promotion, firing), housing (renting, buying, mortgage) or in interactions with police (stopped, searched, threatened).

The researchers calculated a score for self-perceived interpersonal racism in everyday life by averaging participants’ responses to the first set of five questions and divided the participants into quartiles of the score; this analysis found no association with reported experiences of racism in everyday life and increased risk of CHD.

The researchers also calculated a perceived interpersonal racism score for interactions that involved jobs, housing and police interactions by adding up the positive responses to those three additional questions. The self-perceived interpersonal racism scores ranged from 0 (no to all three questions) to 3 (yes to all three questions). The researchers’ analysis of perceived interpersonal racism scores for interactions that involved jobs, housing and police found that women who reported experiencing racism in all three categories had an estimated 26% higher risk of heart disease relative to those who answered no to all three questions.

“Structural racism is real — on the job, in educational circumstances and in interactions with the criminal justice system,” said Michelle A. Albert, M.D., M.P.H., FAHA. Albert is president of the American Heart Association, professor of medicine at the University of California at San Francisco (UCSF), Admissions Dean for UCSF Medical School and an author on the study. “Now we have hard data linking it to cardiovascular outcomes, which means that we as a society need to work on the things that create the barriers that perpetuate structural racism.”

The study’s limitations include that the investigation was limited to self-perceived interpersonal racism, which is subjective by definition and may reflect different perceptions of levels of actual racism for each individual, and this information was collected from study participants only once. Also, despite efforts to adjust the findings based on a comprehensive list of additional factors — age, neighborhood socioeconomic status, education level, body mass index, geographic region, physical activity, smoking, history of diabetes and history of hypertension — the study is observational in nature and may still have some unmeasured factors or other elements that may influence the results that were not included, Sheehy said.

“Future research is needed to examine the impacts of structural racism on cardiovascular health,” Sheehy said, “as well as to evaluate the joint impacts of perceived interpersonal racism and structural racism.”

Co-first author is Max Brock, M.D.; additional co-authors include Julie R. Palmer, Sc.D. M.P.H.; Yvette Cozier, D.Sc.; and Lynn Rosenberg, Sc.D. Authors’ disclosures are listed in the abstract.

This study was funded by the National Institutes of Health.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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Additional Resources:

• Multimedia is available on the right column of release link https://newsroom.heart.org/news/higher-levels-of-perceived-racism-linked-to-increased-risk-of-heart-disease-in-black-women?preview=35927364a33d66dfdb64f9bbedbc207e
  

  • Video interview: Shanshan Sheehy, Sc.D., lead author of the study and an assistant professor at the Slone Epidemiology Center at Boston University and Boston University’s Chobanian & Avedisian School of Medicine.
  • Video interview: Michelle A. Albert, M.D., M.P.H., FAHA, president of the American Heart Association, professor of medicine at the University of California at San Francisco (UCSF), Admissions Dean for UCSF Medical School and an author on the study.

• AHA news release: Perceived discrimination increased the risk of worse health outcomes after a heart attack (October 2022)
• AHA news release: Representation matters, especially when it comes to your health (October 2022)
• AHA news release: Help for Latinas and Black women at higher risk of out of hospital cardiac arrest death (August 2022)
• For more news from AHA EPI Lifestyle Conference 2023, follow us on Twitter @HeartNews and #EPILifestyle23.

The American Heart Association’s EPI/LIFESTYLE 2023 Scientific Sessions is the world’s premier meeting dedicated to the latest advances in population-based science. The meeting will be held Tuesday-Friday, February 28 – March 3, 2023, at the Omni Boston Seaport in Boston, Massachusetts. The primary goal of the meeting is to promote the development and application of translational and population science to prevent heart disease and stroke and foster cardiovascular health. The sessions focus on risk factors, obesity, nutrition, physical activity, genetics, metabolism, biomarkers, subclinical disease, clinical disease, healthy populations, global health and prevention-oriented clinical trials. The Councils on Epidemiology and Prevention and Lifestyle and Cardiometabolic Health (Lifestyle) jointly planned the EPI/Lifestyle 2023 Scientific Sessions. Follow the conference on Twitter at #EPILifestyle23.

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