“It’s not as simple as “heart failure is passed on genetically in certain groups,” Dr. Morris adds. Since some genetic mutations that are linked to the condition—such as transthyretin amyloidosis, which can cause a buildup of abnormal protein deposits in the body that can lead to heart failure—are most commonly found in people of African ancestry, it follows that this mutation may be more prevalent in Black people, she explains. But there are many other complex factors at play, including generations of systemic racism. Segregation is one example that experts point to: “As an African American, I am more likely to have inherited certain traits,” Dr. Morris explains, but that is, in part, because society “kept races apart from each other—intentionally.”3

There are also “traditional” risk factors to consider.

We know certain aspects of a person’s overall well-being contribute to their chances of developing heart disease, including heart failure, which is supported by the existing evidence gathered in research, Dr. Khan says.4,5 For example, hypertension is a key risk factor; your heart has to work harder if your blood pressure is high, which can stiffen its muscle or weaken it over time, according to the Mayo Clinic—and about 55% of Black American adults have high blood pressure, per the American Heart Association (AHA).

Other heart failure risk factors include being over 65 years old; having diabetes, sleep apnea, and/or kidney disease, among other chronic conditions; having a high BMI (many experts acknowledge that this measure of health is flawed and rooted in racism—but we want you to know it’s likely to come up in your care at some point); not eating enough fruits, vegetables, and whole grains; smoking and heavily using or consuming other substances like alcohol; and not getting enough exercise, according to the National Heart, Lung, and Blood Institute. These factors can help your doctor evaluate whether you’re at an increased risk of heart problems in general, Dr. Khan says, and nearly all of them disproportionately affect communities of color in some way, per the AHA.

Of course, there isn’t a simple explanation as to why high blood pressure and diabetes, for example, are so prevalent in Black communities. Does it come back to genetics? Societal factors? “It’s very hard to separate the reasons out because they are very interconnected,” Dr. Khan says.

Social determinants of health are also a big deal.

The term ”social determinants of health” refers to “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks,” per the US Department of Health and Human Services.

This includes things like a person’s financial stability, their access to and quality of health care, their ability to find nutritious food and exercise opportunities in their community, as well as the likelihood of facing racism, discrimination, and violence in their everyday life. In a 2022 paper coauthored by Dr. Khan and published in Clinical Cardiology, Northwestern University researchers note that a variety of social determinants of health have been associated with heart failure risk, including things like a lack of quality education, living in a low-income household or community, living in a region with a poor public health infrastructure, and a lack of health insurance, among others.6



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