Cardiovascular Disease

Cardiovascular disease (CVD) refers to the dysfunctional conditions of the heart, arteries, and veins that supply oxygen to vital life- sustaining areas of the body like the brain, the heart itself and other vital organs. Since the term cardiovascular disease refers to any dysfunction of the cardiovascular system there are many different diseases in the cardiovascular category, and many of these diseases are strongly intertwined. Ischemic Heart Disease is the medical idiom for the obstruction of blood flow to the heart.

It is usually due largely in part to excess fat or plaque deposits that narrow the veins that provide oxygenated blood to the heart. This excess fat buildup and plaque are respectively known as arteriosclerosis and atherosclerosis. Hypertension is frequently a result of both arteriosclerosis and atherosclerosis, and can lead to more serious CVDs, such as angina attack (an acute and squeezing chest pain due to inefficient blood flow to the heart), and myocardial infarction( the sudden death of part of the heart muscle). A stroke is a CVD that occurs when there is in inadequate oxygen flow to the brain.

An abnormally high or abnormally low heart rate because of the disruption of the natural electric impulses of the heart is called cardiac arrhythmia. Carditis and endocarditis, the infection and inflammation of the heart, can occur as a result of a weak immune system, liver problems, heart surgery, or an autoimmune disorder. A number of health -related behaviors contribute remarkably to the onset cardiovascular disease. Smokers are two times as likely to have a heart attack as non-smokers, and one fifth of the annual 1,000,000 deaths from CVD can be attributed to smoking.

A sedentary lifestyle increases one’s risk of heart disease. However, America remains predominantly sedentary, and more than half of American adults do not practice the recommended level of physical activity, while more than one-fourth are completely sedentary Between 20-30%, approximately 58 million people, of the nation’s adults are obese. Obesity severely increases risk for hypertension, high cholesterol, and other chronic diseases which have been proven to cause heart disease. As one can clearly see cardiovascular disease is a very broad topic encompassed by many different malfunctions and causes.

The all encompassing nature of cardiovascular disease in no way takes away from the severity of it. In fact, CVD is the leading cause of death in the United States. In the US one person dies every 30 seconds from heart disease, that’s over 2,600 people every day. As serious a problem as heart disease is to the general population, cardiovascular disease is ravaging the African American community. In 2001 alone, 48,939 black males and 56,821 black females died of heart disease. Clearly heart disease is more than just a problem in the African American community; it is a matter of life or death.

Which raises the question, why do African Americans have such a higher propensity for heart disease? Naturally, there is a multi-faceted answer. African Americans have a higher occurrence of the health related behaviors that lead to heart disease, are biologically more apt to develop risk factors related to heart disease, and have a greater likelihood to be apart of a social network with an increased incidence of CVD. A large number of biological variables are thought to be related to the greater prevalence of heart disease in African Americans.

These variables include a greater degree of sensitivity to dietary sodium, increased cardiovascular reactivity, increased vascular resistance, and increased prevalence of LVH, hyperinsulinemia, and lower rennin or prostaglandin levels. Most importantly however, is the predisposition to hypertension and dyslipidemia. Hypertension is described as blood pressure values above 120/80 mm hg, and often results from excess fat or plaque build up because of the extra effort it takes to circulate blood. These blockages shortchange many of the areas of the body of blood supply, even though the heart is working at an increased rate to circulate.

The body is often able to mask the subtle damage due to the extra work the cardiovascular system is undergoing, but not forever, and for that reason hypertension is often referred to as “the silent killer”. In fact, approximately 27% of African Americans with hypertension are unaware of their condition. Unfortunately, many times the first warning signs of hypertension are angina attack, stroke, or even myocardial infarction, all severe cardiovascular diseases. Dyslipidemia is defined as a total cholesterol level greater than 200 mg/dl. LDL cholesterol above 130 mg/d, HDL cholesterol bellows 35 mg/dl; and a lipoprotein level greater than 30 mg/dl. An elevated cholesterol level rigorously lends itself towards conditions such as atherosclerosis, which can in turn lead to more serious CVDs. However, cholesterol is not actually a damage mechanism but rather a risk factor for increased risk of heart disease. In many aspects of health and disease, biological and genetic variables are considered to be the most important in reaching a medical solution to a problem.

Nevertheless, evidence suggests that social disparities between African Americans and the rest of the American population may have a greater influence over disease prevalence then genetic differences. It is common knowledge, that as a race African Americans are far more likely to live and remain living below the poverty line. For this reason, the African American community does not always enjoy the healthcare benefits that an increased socio-economic status would bring. Therefore, access to healthcare and healthcare information is not a constant option.

For example, 32% of African Americans with hypertension are receiving inadequate treatment. Lower levels of education, employment status, and income are also socio-economic risk factors towards CVDs, , which lead to unnerving statistics such as the 17% of African Americans with hypertension that are aware of their condition, but are not being treated for it. Being overweight, leading a sedentary lifestyle, and smoking are the most commonly cited modifiable risk factors that contribute to an increased prevalence in heart disease. All of which are behaviors commonly exercised within the Black community.

Additionally, patterns of diets and exercise are behavioral risk factors that augment the incidence of heart disease in the African American population as a result of their culture. Because of the lower socio-economic status, African Americans are not commonly awarded the luxury of eating the healthiest food or taking the time out to exercise. Also, culturally African Americans are a sedentary people. Activities such as card playing, TV watching, and other non athletic instances are strongly interweaved within the tapestry of African American culture.

According to a BRFSS survey conducted in1996, the median percentage of respondents reporting no leisure time activities (broadly defined as any exercise, recreation, sports, gardening or walking) was 38. 2% for African Americans. Cardiovascular disease has already been acknowledged as the gravest quandary affecting African Americans today. Consequently, the prevention and treatment of CVDs has moved to the forefront of research in the African American medical arena. Prevention of heart disease and its risk factors are the primary concern, as once one contracts a CVD the principal method of treatment is medication and surgery.

The first step in the prevention of heart disease and its risk factors are to modify those behavioral factors over which one has control. Obesity, smoking, and inactivity have been identified as the most common behavioral factors leading to heart disease. These issues are important because curative lifestyle changes can result in significantly reduced cardiovascular threat. A healthy diet and exercise program are also two ways for one to increase heart health, and decrease the onset of the biological causes of heart disease.

After taking control of the things one can directly, one must focus on those things beyond their control. Yes, African Americans have a huge predisposition to hypertension, and there is nothing that they as a community can do to change that. However by focusing on prevention, assessment of individual risk profiles, identification of high risk patients, and early intervention, hypertension can be curbed and with it the peril of heart disease. Prevention of high blood pressure through screening is essential.

Hypertension is easily detected and normally controllable, but since it has virtually no symptoms 32% of people with hypertension are unaware of it. In the stadium of risk assessment, medical professionals need to impress upon their African American patients the prospective cardiovascular conclusions of their lifestyle choices and make unwavering endeavors to educate and support these patients and their families in their attempts to lead improved lives in the areas of diet, physical activity, smoking, and alcohol use.

This can be accomplished by translating medical targets into practical goals such as, consuming no more than 2 beers a day, gradually losing weight, or increasing aerobic fitness. Next, there is the issue of treatment. Selecting an appropriate first line medication, as well as achieving and maintaining an appropriate target blood pressure goal, is the chief objective of therapy. Medications such as aspirin and diuretics are effective in all groups of hypertensive patients.

Since hypertension in African Americans has been characterized by salt sensitivity and low renin levels there is the potential for a reduced response to many types of blood pressure medications, and therefore combinations of the many types is often the most effective method. Lastly, there are those who are already plagued by heart disease. When an individual is already a victim of heart disease it is essential that they modify their lifestyle in order to be as healthy as possible. With this being said, the traditional approach to combat CVDs is medication and surgery.

However, it has become increasingly necessary to obtain a second and even a third opinion because surgery is expensive, and physically invasive and traumatic for the heart patient. Cardiovascular disease is an epidemic that is afflicting this great nation. It makes up 42% of all deaths, and CVD, principally coronary artery disease and stroke, is the nation’s leading killer for both men and women among all racial and ethnic groups. However, CVD affects one part of the population in an incredibly serious manner. This section is the African American community, and among blacks age 20 and over, 40. % of men and 39. 6% of women are affected by CVD. General practitioners need to focus on the causal biologic and social factors, such as background, heritage, and diet that add to the disparity in the prevalence of CVD in the black community. As well as, efforts to boost consciousness about the associations between lifestyle choices and cardiovascular outcomes must be strengthened and expanded. This multi-tiered approach is the only way to combat this killer, and salvage the lives our the African American people.

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