Despite having lower cholesterol levels than other racial groups, African Americans still die from heart disease at higher rates. What’s behind this disparity, and does diet play a role?

checking blood pressureShare on Pinterest
Eddie Pearson/Stocksy United

Cardiovascular (heart) disease is the leading cause of death in the United States. Heart disease is an umbrella term for various conditions that affect the heart. The most common type of heart disease is coronary artery disease (CAD).

Rates of heart disease are decreasing for all races and ethnicities in the United States. Still, compared with other groups, Black adults are 30% more likely to die from heart disease than non-Hispanic white people.

Among 18- to 49-year-olds, Black people are twice as likely as white people to die from heart disease.

High cholesterol is a major risk factor for heart disease, especially CAD. But African Americans actually tend to have lower cholesterol levels than other groups.

So, while cholesterol is an important risk factor, other contributors perhaps deserve a closer look. For example, African Americans have higher rates of diabetes and high blood pressure.

We also need to take a closer look at the social determinants of health. Among Black people, there can be major barriers to accessing healthcare. There are also higher rates of poverty and lower rates of health insurance. Lack of healthcare access prevents early screening and management of risk factors.

Our bodies naturally make cholesterol. It’s not all bad. We need some cholesterol to build cells and hormones.

Specific proteins carry cholesterol around our bodies. One is called low-density lipoprotein (LDL), aka “bad” cholesterol. When LDL is too high, it can start to build up along the walls of the blood vessels. This can harden and narrow blood vessels, contributing to CAD.

Another carrier of cholesterol is called high-density lipoprotein (HDL), aka “good” cholesterol. HDL brings cholesterol to the liver to get broken down. A higher amount of HDL helps protect against heart disease.

Nearly 2 in 5 people in the United States have high cholesterol. Compared with other groups, African Americans are more likely to have lower LDL levels.

So, other factors beyond cholesterol increase the risk for African Americans.

A small amount of our cholesterol comes from our food choices, but it’s mainly genetic: If you have a close family member with high cholesterol, you’re also more likely to have higher levels.

Foods high in saturated fat may raise LDL. Other foods may help lower LDL.

Foods that may raise LDLFoods that may lower LDL
? red meat
? processed meat
? full fat dairy
? coconut		? vegetables
? fruits
? whole grains
? beans
? nuts
? seeds

Black people in the United States have a variety of cultures and food traditions. Food is more than just nutrients. We use food to celebrate, provide comfort, and connect with others.

But dietary guidelines can sometimes be rooted in racism. They often group soul foods or Southern foods together and label them as unhealthy.

And like most research, nutrition studies tend to lack diversity. For many reasons, research has not represented the actual diversity in the population.

Family history plays a part in your risk of heart disease. If you can find out your family history, it’s worth asking. Heart disease, diabetes, high blood pressure, and high cholesterol can all run in families.

Genetics is never the whole story, but it may give some clues about your own health.

Doctors often prescribe statins, drugs that lower LDL, for people with a family history of high cholesterol or heart disease. Compared with white people, African Americans are less likely to receive statin therapy. When they do use statins, they’re less likely to be prescribed the correct dose to get LDL to target.

It’s also worth noting that studies exploring the use of statin therapy have mainly focused on white men. This is despite higher rates of heart disease in many historically marginalized groups. There is a lack of large, high quality studies to understand how statins work in People of Color.

Who’s most at risk of heart disease?

There are several risk factors for heart disease. Some are things you can control, and others are out of your control.

Risk factors for heart disease include:

  • high LDL (bad) cholesterol
  • low HDL (good) cholesterol
  • high blood pressure
  • diabetes
  • older age
  • family history of heart disease
  • lack of physical activity
  • stress
  • smoking

Certain conditions can increase your risk of developing heart disease. This is especially true if the conditions are not well managed.

High cholesterol is one risk factor. But there are other conditions that more disproportionately affect African Americans.

According to the Centers for Disease Control and Prevention (CDC), 19.6% of Black adults in the United States live with diabetes. This compares to 13% of white adults.

Meanwhile, 42.1% of Black adults have high blood pressure. Among white adults, the CDC estimates that the rate is 28.7%.

There are things you can do to lower your risk of heart disease.

Regular checkups

To help monitor for early signs of heart disease, regularly check your:

Early detection allows for better management. Talk with a healthcare professional about how often you should check these numbers.

Diet

A high fiber diet can help manage your cholesterol and blood sugar levels.

Good fiber sources include:

  • a variety of fruits and vegetables
  • nuts and seeds
  • grains, such as oats, barley, millet, brown rice, and whole wheat or whole grain products
  • beans, peas, and lentils

Lifestyle

Regular exercise is good for your heart. If you are able, include a variety of activities. Stretching, aerobic exercises, and strength training can all improve your health. Choose something you enjoy doing.

If you are a current smoker, consider quitting or cutting down. Ask a healthcare professional if you need support with this.

Systemic changes

While there is much you can do on your own to improve your heart health, we still need to take action to overcome the systemic barriers in place. Some key actions include:

African Americans have a greater risk of heart disease than other groups. While cholesterol is a major risk factor for heart disease, it may not be a major contributor to this disparity in rates.

African Americans do not have higher rates of high cholesterol than other groups. In fact, they often have better levels.

Other factors, such as high blood pressure and diabetes, may contribute more to heart disease rates among African Americans. Some causes for this include diet, genetics, and family history. But much is due to disparities that prevent access to preventive care and healthy living.

There are some things you can do on an individual level. But we also need to see big-picture changes to ensure better health outcomes for all.