Touching Hearts

If asked what disease is the number one killer of Americans, most people would say cancer. But the truth is, cardiovascular disease (CVD) kills more Americans than any other disease. In fact, it is the leading cause of death in both genders and all ethnic groups.

According to the Centers for Disease Control and Prevention (CDC), more than 870,000 Americans will die of heart disease and stroke every year. Compare this to the American Cancer Society’s estimate that 565,650 Americans will die from cancer this year. In its December 2007 report Heart Disease and Stroke Statistics – 2008 Update, the American Heart Association (AHA) documented that in 2004 there were 869,724 deaths due to heart disease versus 553,888 deaths from cancer. The numbers speak for themselves: More Americans are dying from heart disease.

These grim statistics are even more alarming in the African American population, where research studies have shown that the prevalence of heart disease is highest. The AHA reports that cardiovascular disease claims over 100,000 African American lives each year. What’s less well known is that more than half of these fatalities are women. According to AHA, 53,850 African American females died from heart disease in 2004, compared to 48,083 African American males.

In our society there is a long-held misconception that heart disease mainly affects men. This lack of awareness that CVD is not just “for men only” is not only present in the general public but also to some degree among health care professionals. AHA reports that less than one in five physicians recognize that more women die of heart disease than men. The common belief has been that the hormone estrogen protects women from heart disease risk until menopause.

While it is true that heart disease is the leading cause of death in women 65 and older, data from the CDC show that heart disease is ranked as the third leading cause of death in women ages 25 to 44 and the second leading cause of death in women ages 45 to 64. In other words, young and pre-menopausal women are affected by and even die from heart disease.

There are two types of risk factors for heart disease: non-modifiable and modifiable. The non-modifiable category includes gender, race, age and family history. These things are beyond a person’s control and can’t be changed. Risk factors that can be modified are hypertension, diabetes, smoking, obesity, elevated cholesterol and physical inactivity. Making changes in these areas can play a significant role in helping people reduce their risk of heart disease morbidity and mortality.

Higher Awareness = Lower Risk

African American women have a high rate of occurrence for many of these modifiable risk factors. Yet studies have shown that, compared to women of other races and ethnicities, they are the least aware of their risk or of the prevalence of heart disease in women. Another disparity is that black women develop these risk factors at a younger age. AHA reports the following statistics for African American women age 20 and older:

•  46.6% have high blood pressure
•  13.2% have diabetes
•  17.2% smoke
•  79.6% are overweight or obese
•  34% are physically inactive.

Studies have also shown that CVD risk factors and prevalence are higher in populations with low income levels. This puts low-income African American women at even higher risk for developing heart disease.

As patient advocates working on the front lines of health care, nurses must reach out to these vulnerable women to create awareness and teach them how they can lower their heart disease risk. This requires nurses to become active in communities with a high African American population, including low-income communities. We must go where the need is, because many times those in need do not seek help, especially if they are unaware of their need.

To gain ground in the fight against heart disease disparities in African American women, nurses must increase awareness not only in the community but also among themselves. We must educate ourselves and our co-workers. On an individual level, we can begin by reading current journal articles and research studies relating to heart disease, race and gender, and by attending seminars and conferences. The information we gain can then be passed along to our co-workers. This can be done by personally sharing articles we have found informative and by requesting time at staff meetings to present what we have learned.
In addition, the CDC, AHA and other organizations offer a wealth of free information and tools—including programs designed specifically for women and African Americans—that nurses can use to increase public awareness of heart disease risks in communities of color (see next page). These organizations’ Web sites also include links to other informative and helpful resources on the Internet.

Where to Begin in the Community

In the African American community the church plays an important role, especially in the lives of women. Churches serve as a source of support and influence, as well as a meeting place for many women. People in the community are comfortable in the church and are willing to attend health-related workshops held there. This is a good place for nurses to begin reaching out to black women to educate them about heart disease.

Partnering with other organizations can help maximize the effectiveness of your outreach efforts. For example, you can contact your local or state health department and form a joint effort to provide heart health workshops at community churches. The health department can provide free cholesterol, blood pressure and blood glucose screening to those who attend. These workshops can be offered quarterly or biannually at different churches in the community.

Local colleges that have nursing programs are another good resource. Contact them to see if some of their nursing students would be available to assist with blood pressure and blood glucose testing. Invite black sororities and women’s clubs to help organize and sponsor community workshops and health fairs. The health care facility where you work may also be interested in being involved in this project.

During the workshop, nurses can present information on the prevalence of heart disease in African American women, risk factors, signs and symptoms, management and prevention of heart disease. Many free educational materials that can be used to communicate this information are available from programs like AHA’s Search Your Heart and the National Institutes of Health’s The Heart Truth. Through these workshops, vulnerable women can become empowered by gaining knowledge about heart disease, their risk and what they can do to decrease it.

Providing free screenings will help identify women who do not have regular health care providers, those with abnormal findings and those at high risk. These women can then be connected with health care services available from their community health department. The health department can obtain contact information during the screenings to follow up with those women who need treatment or referrals.

Once women are aware of the problem and their risk, nurses can help them organize walking groups and brainstorm other ways to increase their activity level.  Resources available from the AHA, such as heart-healthy recipe books, can be used to teach women how to modify their diets to decrease cholesterol. You can also provide information on the management of diabetes, high blood pressure and any existing heart disease. Women who smoke can be referred to smoking cessation programs. These activities focusing on reducing modifiable risk factors will help women make positive changes in their lifestyle and their health.

Going out into the community enables nurses to reach a larger number of women—including those who might not attend workshops if they were offered outside of their communities or in health care settings—and those with the highest risk. This article offers suggestions on how to begin and where to find additional ideas. Armed with personal knowledge, available resources and community partners, nurses can make a difference in the fight against heart disease disparities in African American women.