Our heart beats an average of 2.5 billion times during our lifetime! It pumps blood up to our scalp and right down to our pinky toes. Even when we are asleep, it continues nurturing our body.
Sadly, many of us have a family member living with a disease of the heart or its blood vessels – maybe you have a parent with high blood pressure, or a loved one who suffered a heart attack? These are considered Cardiovascular Diseases (CVDs) and they are the second-leading cause of death in Canada.1 When our heart’s pumping activity is impaired or our blood vessels are blocked, our organs do not receive sufficient nutrients and oxygen. Our organs, especially our brain, cannot handle insufficient blood flow for more than a few minutes so they start to shut down, and death becomes inevitable.
Now, I am sorry to be the bearer of further bad news. The burden of CVDs is not proportionately shared amongst our society.2,3 In fact, the 2019 American Heart Association guidelines identified socio-economic inequities, including race, as a strong determinant of CVD risk internationally.3 Black communities in North America disproportionately experience higher rates of CVDs.
I have lost many family members and friends to CVDs.
How have I dealt with this? I’m training to become a medical doctor so that I can address the impact of CVDs on our community. To promote our collective health, I will share with you some valuable prevention strategies, which are grounded in our rich African ancestry and we can easily build into our lives.
What Causes CVD? Can We Prevent it?
Like many chronic conditions, CVDs develop due to a combination of genetic and lifestyle factors.
Let’s start with the genetic factors. There’s conflicting research about whether specific African ethnicities carry a mutation—that is, a change in our genetic code—which makes us more susceptible to a faulty cardiovascular system.4–6 Given the large variability in the ancestry of Black people in Canada, and the lack of sufficient research in this field, it remains unclear if this is the case. Regardless, our genetics are what we call “non-modifiable risk factors,” meaning that we cannot change them, and, thus, it is futile to focus on them. In the distant future, when therapies allow us to address genetic risk factors, and are broadly accessible, we can revisit this. Other than genetics, non-modifiable risk factors include age and gender.7
On the other hand, there are “modifiable risk factors,” which include obesity, tobacco smoke, high blood cholesterol (hypercholesterolemia), high blood pressure (hypertension), physical inactivity and diabetes.7 These are factors that we can reverse, treat, or control, although there is one more piece of bad news I must share.
Evidently, there is a higher prevalence of modifiable CVD risk factors among Black people. Relative to white folks, Black people in Canada are at a higher risk of obesity, hypertension, and diabetes.8 Additionally, low-income Black women in Canada have the worst outcomes when it comes to hypertension and diabetes.9 This points to the inter-related impact of socioeconomic status on health outcomes.
Why do Black People have Worse CVD Modifiable Risk Profiles and Outcomes?
Firstly, the racial and/or ethnic discrimination we experience makes us feel hypervigilant and is thought to induce physiological distress. Even after we control for the inter-related impact of age, gender, and socioeconomic status that are associated with further discrimination, racism significantly increases the prevalence of hypertension in Black communities.10 Our body recognizes and responds to the trauma.
In addition, when we, or our ancestors, migrated from Africa to the West, our eating habits changed as we acclimatized. Specifically, the diet we adopted contains high levels of salt, saturated fat and cholesterol, while being low in fruits and vegetables.11,12 Also, research studies suggest that Black hypertensive patients have low adherence to prescribed diets, such as the DASH diet (Dietary Approaches to Stop Hypertension) for reasons including the difficulty in finding time to prepare healthy meals and incorporating them into a daily routine.12,13 These dietary trends are associated with an increased risk of developing CVDs.
It is not all bleak news though. Let’s explore some of the many ways we can ‘modify’ these risk factors and heal our hearts, both literally and figuratively.
Many physicians are leading research and community-based projects to elucidate the causes of CVDs and address the high CVD rates in Black communities. For instance, Dr. Sean Wharton is a prominent Internist, researcher, and serves as the Medical Director of the Wharton Medical Clinic in Burlington, Ontario. This clinic is a community-based internal medicine weight management clinic, which adopts a comprehensive, multidisciplinary approach in the long-term treatment of obesity. As well, Dr. Husam Abdel-Qadir is an award-winning Cardiologist who specializes in women and cancer therapy-induced CVDs. They are pushing for more equitable medical practices that improve our community health.
How Can We Heal Our Heart?
1. Black Joy!
My first recommendation is a phrase that I’ve recently learned and has quickly become my favourite: “Black Joy is Our Resistance.”
Our community and allies are working relentlessly to alleviate racial injustices. But until systemic racism is eliminated from the contributing CVD risk factors, we need to promote our collective healing together. We need to give ourselves the mental and physical space to laugh, enjoy life, and celebrate ourselves and one another. We need to intentionally preserve our sanity when society judges us unfairly and deems us unworthy and replaceable. This can look different for each one of us—whether it is support from a friend, family member or loved one, relying on allies, psychotherapy, setting boundaries, or prioritizing our wellbeing. Listening to podcasts like Race, Health and Happiness can be a great wellness tool. I pray for our emotional, mental, and existential liberation—the day that our joy becomes normalized!
2. Reclaim our Ancestral Habits!
Our ancestors developed healthy lifestyles. One way to address our high CVD rates could be to reclaim these traditions. Traditional African cuisine is rich in beans, peas, whole grains, fruits, nuts, and vegetables. It has been praised as one of the healthiest diets in the world. It also aligns with the 2020 Hypertension Canada Guidelines,14 which aim to mitigate hypertension among at-risk individuals.14 Shocking…I know! In fact, there is an “African Heritage Food Pyramid” which meets dietary guidelines and is based on our ancestor’s resourcefulness and culinary legacy. It’s time to ask your grandparents for some traditional food recipes! For me, eating the delicious foods of my ancestors energizes my soul by connecting me to my roots, while fuelling my body with nutrient-dense foods.
3. Dancing, moving, and exercise.
Did you know that dancing is a form of exercise? And rhythm is deeply abundant in our communities. Make use of this talent. Not only is dancing considered a de-stressor from daily life struggles, but it also carries many fitness benefits. As an aerobic moderate-intensity activity, dancing can apply towards exercise recommendations. Diabetes Canada suggests 150 minutes per week, while the 2020 Hypertension Canada Guidelines suggest 30-60 minutes of dancing for 4-7 days a week.14,15 The bottom line is that we need to dance more often…it’s fun AND healthy!
4. Take Control Over Your Health!
The most valuable lesson that two years in medical school have taught me is that it is A LOT easier to prevent disease than it is to try and treat it. I’ve learned how important it is to advocate for our own health and to consistently make minor, yet significant, preventative improvements. An invaluable partner in this journey can be our Family Doctor, especially when they are an ally and appreciate our specific social circumstances. Centers like the TAIBU Community Health Centre and the Black Creek Community Health Centre provide interprofessional care that is culturally sensitive and safe for our Black community in Ontario. The Black Health Alliance also provides an extensive list of community services. If you don’t live near either of these, take your time to find a family physician that you can trust, and one who will advocate for your needs, whether medical or psychosocial.
To conclude, our Black ancestors survived AND thrived! Similarly, we can incorporate small but effective preventative measures, that are culturally appreciated, into our daily lives to significantly improve our CVD risk profile and overall health. Celebrating the wonderful values and traditions that our ancestors left us is how we can promote the collective healing of our hearts!
References
- Government of Canada SC. Leading causes of death, total population, by age group. Published November 26, 2020. Accessed January 4, 2021. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401
- HEALTH INEQUITIES. Accessed February 5, 2021. https://blackhealthalliance.ca/home/health-inequities/
- Arnett Donna K., Blumenthal Roger S., Albert Michelle A., et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678
- Rao S, Segar MW, Bress AP, et al. Association of Genetic West African Ancestry, Blood Pressure Response to Therapy, and Cardiovascular Risk Among Self-Reported Black Individuals in the Systolic Blood Pressure Reduction Intervention Trial (SPRINT). JAMA Cardiology. Published online November 13, 2020. doi:10.1001/jamacardio.2020.6566
- Genetic misdiagnoses of heart condition in black Americans. National Institutes of Health (NIH). Published September 2, 2016. Accessed February 6, 2021. https://www.nih.gov/news-events/nih-research-matters/genetic-misdiagnoses-heart-condition-black-americans
- Saab KR, Kendrick J, Yracheta JM, Lanaspa MA, Pollard M, Johnson RJ. New Insights on the Risk for Cardiovascular Disease in African Americans: The Role of Added Sugars. JASN. 2015;26(2):247-257. doi:10.1681/ASN.2014040393
- Understand Your Risks to Prevent a Heart Attack. www.heart.org. Accessed February 5, 2021. https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack
- Gasevic D, Ross ES, Lear SA. Ethnic Differences in Cardiovascular Disease Risk Factors: A Systematic Review of North American Evidence. Can J Cardiol. 2015;31(9):1169-1179. doi:10.1016/j.cjca.2015.06.017
- Gagné T, Veenstra G. Inequalities in Hypertension and Diabetes in Canada: Intersections between Racial Identity, Gender, and Income. Ethn Dis. 27(4):371-378. doi:10.18865/ed.27.4.371
- Brewer LC, Cooper LA. Race, Discrimination, and Cardiovascular Disease. AMA Journal of Ethics. 2014;16(6):455-460. doi:10.1001/virtualmentor.2014.16.6.stas2-1406.
- Luke A, Cooper RS, Prewitt TE, Adeyemo AA, Forrester TE. Nutritional consequences of the African diaspora. Annu Rev Nutr. 2001;21:47-71. doi:10.1146/annurev.nutr.21.1.47
- Chan Q, Stamler J, Elliott P. Dietary Factors and Higher Blood Pressure in African-Americans. Curr Hypertens Rep. 2015;17(2):10. doi:10.1007/s11906-014-0517-x
- Academy USS. Dietary Habits of African Canadian Women: A Sampled Survey. The Sport Journal. Published April 9, 2012. Accessed February 6, 2021. https://thesportjournal.org/article/dietary-habits-of-african-canadian-women-a-sampled-survey/
- Rabi DM, McBrien KA, Sapir-Pichhadze R, et al. Hypertension Canada’s 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Canadian Journal of Cardiology. 2020;36(5):596-624. doi:10.1016/j.cjca.2020.02.086
- Sigal RJ, Armstrong MJ, Bacon SL, et al. Physical Activity and Diabetes. Canadian Journal of Diabetes. 2018;42:S54-S63. doi:10.1016/j.jcjd.2017.10.008
