Warning signs: more than 40% of blacks suffer from a cardiovascular condition. Knowing the risk factors and treatment options could keep you from becoming a statistic.

WHEN R&B SINGER GERALD LEVERT DIED FROM A heart attack last year at the age of 40, many of his fans were stunned. But internationally renowned cardiologist Christopher J.W.B. Leggett, director of cardiology for Medical Associates of North Georgia in Canton, Georgia, says such deaths occur every day as a result of single or multiple risk factors of heart disease such as obesity, hypertension, and diabetes. With more than 70 mil-lion Americans living with a form of heart disease, it is the most likely cause of death. But, says Leggett, "the disproportionate number of African Americans who die from cardiovascular disease is staggering; it's epidemic." Of 5 million individuals diagnosed with heart failure, 750,000 are African American, with an estimated increase to 900,000 expected by the end of the decade. In 2004, the American Heart Association revealed that an alarming 44.6% of black males and 49% of black females had cardiovascular disease, compared with 37.2% and 35% of whites, respectively, and that black women are 69% more likely to die from a heart attack than white women. Although risk factors are identical across racial groups, African Americans often present multiple factors and symptoms that are likely to be more advanced and aggressive. Blacks remain the most underrepresented and underserved population in research studies, clinical trials, diagnoses, and treatment. Despite exhaustive studies of heart disease in whites, scientists have only recently begun to study the presentation of the disease in African Americans. "Blacks still receive less cardiovascular care, even for acute symptoms. They are less likely to receive EKGs, cardiac testing, bypass surgery, or even an aspirin," says Malcolm Taylor, M.D., assistant clinical professor at the University Medical Center in Mississippi, and director of the Congestive Heart Failure Clinic at the Mississippi Heart Institute at St. Dominic-Jackson Memorial Hospital.

In fact, according to Leggett, 30% fewer African Americans have access to the necessary procedures or treatments that could save their lives. But it is possible to reverse medical predictions through education and positive lifestyle changes.

Why we're at risk:

Previously, age and gender were the main determinants of heart disease. This is no longer true, as the disease has been diagnosed at younger ages, and women account for 51% of heart disease patients. Secondary risk factors include high levels of triglyceride, the most common type of fat in the body, which can increase the likelihood of high cholesterol and diabetes; excessive alcohol intake; and the occurrence of a previous heart attack or stroke. "Diabetes is not only a disease involving glucose, it also causes premature aging of the blood vessels. That's why the No. 1 cause of death for diabetics is cardiovascular diseases," says Taylor.

The occurrence of hypertension in African Americans is the highest in the world and plays a significant role in cardiovascular complications. Elijah Saunders, M.D., professor of medicine and head of the Hypertension Section of Cardiology at the University of Maryland's School of Medicine in Baltimore, asserts that one African American dies every hour as a result of high blood pressure, nearly twice as often as whites. "Blacks also develop high blood pressure at younger ages than whites and suffer more damage to their organs as a result of the disease."

In today's competitive environment, a number of socioeconomic factors such as career pressure, unemployment or under-employment, substandard living conditions, racism, and other stress-related conditions also affect blood pressure. How stress contributes to hypertension and heart disease is not known, but the association is quite clear. Stress stimulators often trigger the development of calcification, which causes injury to the cells. The accumulated calcium becomes a marker for atherosclerosis, a thickening and hardening of artery walls that eventually blocks the arteries.

The culture of eating is a particularly egregious contributor to cardiovascular disease. Fried and starchy foods, heavy salt intake, whole dairy, saturated fats, and high cholesterol meals--staples of traditional African American cuisine--can be natural causes of atherosclerosis. Over time, the accumulation of hard to-process food by-products creates a blockage in the vessels that eventually compromises the arterial walls. Americans' ever-expanding waistlines are another contributor, though thin doesn't automatically mean healthy. Lisa Jubilee, nutritionist and co-founder of Living Proof, a nutrition and fitness center in New York City says, "We're observing the phenomenon of the skinny-fat person who looks great dressed up and doesn't weigh much but has substantial fat deposits stored in their midsection, causing an apple shape." The abdominal fat causes heart disease by pressing into the internal organs and decreasing the oxygen supply to various parts of the body.

The prevalence of these risk factors in some communities has led researchers and genetic scientists to explore the existence of intrinsic biological determinants or a human genome that makes certain groups of people more naturally susceptible to certain chronic illnesses such as hypertension and diabetes.

In the meantime, Leggett suggests individuals concentrate on risk management and understanding how certain conditions impact health. "For instance, 80% of diabetics die of heart attacks; and obesity is the No. 1 cause of type 2 diabetes in our country. "If you've got any of those risk factors, you need to be vigilant about controlling each of the problems independently," insists Leggett "That's what will lower your risk."

For more information on risk factors, log on to www.blackenterprise.com.

Know the signs

The body sends a number of signals to let you know it's in trouble. One of the most common symptoms of heart disease is a transient ischemic attack, or mini-stroke. "This occurs when the blood vessels in the brain develop an ulcer caused by high cholesterol. Plaque forms around the crater, which eventually breaks off and makes its way through the bloodstream toward the brain," explains Donna Mendes, M.D., chief of vascular surgery at St. Luke's Hospital in New York City, clinical professor of surgery at the College of Physicians & Surgeons, and the first African American female to become board certified in the specialty of peripheral vascular surgery. "The impacted portion of the brain will suddenly experience decreased blood flow, resulting in a TIA." The part of the body controlled by that portion of the brain becomes impaired, lasting from a few minutes to 24 hours. Other indicators include loss of sensation on one side of the body; loss of vision or motor function; or intermit-tent pain in the calf after walking; the pain results from decreased oxygen and blood flow.

In the case of an impending heart attack, women present much milder and wider symptoms than men. These symptoms are often missed, misdiagnosed, or undertreated by both primary physicians and cardiologists. According to Patrice Desvigne-Nickens, M.D., head of the Cardiovascular Medicine Scientific Research Group at the Bethesda, Maryland-based National Heart Lung and Blood Institute, symptoms include fatigue; shortness of breath; feelings of indigestion and ill health; palpitations; neck, shoulder, and upper back pain; nausea; vomiting; sweating; and lightheadedness.

After weeks of persistent breathlessness and a vague sense of physical unease, Joan Connell, then 42, an accounting professional at ZiffDavis Publishing, went to the emergency room convinced she was having a heart attack. Despite being an over-weight smoker who had been physically inactive for years, she was sent home. A week later she returned and was rushed into emergency bypass surgery that revealed four blocked arteries.

Symptoms in men include angina (chest pain), pressure or discomfort in the chest, or a tingling sensation in the arm or on one side of the body. Women, however, experience a broader constellation of symptoms over a prolonged period of time.

Overall, it is becoming increasingly important for individuals to take full ownership of their health: learning, reading, and researching information that will preserve their health, urges Leggett, "so that you can identify somebody who is incompetent taking care of you. Because [many] don't know the parameters of their conditions," Leggett offers, "they don't know that when someone says 'Go home, you're fine' to say 'I've read that diabetics can feel like this,' or 'Why don't you have a cardiologist [look at me]?"

He laments that many of us are so consumed with pursuing economic and career goals that we too often neglect our health in the process. "Our ability to generate [wealth] is largely dependent on the preservation of our physical existence," he stresses. "You have to have quality physical examinations, know your history, and you have to identify high-caliber physicians around the country. Your health is important enough for you to find out where these people are," Leggett asserts. "You've got men who will drive 100 miles to play golf, but they don't want to drive 10 miles to see a good doctor."

--Additional reporting by Sonia Alleyne

RISK FACTORS

1 HYPERTENSION

2 FAMILY HISTORY

3 CIGARETTE SMOKING

4 DIABETES

5 HIGH BLOOD CHOLESTEROL

6 PHYSICAL INACTIVITY 

Testing and treatment

Take heart. Here are seven diagnostic and treatment methods to save your life:

Some diagnostic tools, such as EKGs, often fail to accurately show heart defects. Here are other screening methods you need to know about:

1 Angiography or arteriogram--a procedure that uses an X-ray and a special dye to see inside the arteries, veins, and heart chambers to detect abnormalities.

2 Carotid Ultrasound--illustrates blood flow patterns and the narrowing of neck arteries.

3 Cardiac Scanning (CT)--examines anatomical abnormalities of the heart chambers and blood supply.

4 Ankle Brachial Index--predicts the presence and the severity of peripheral artery disease. The patient's blood pressure is taken at rest in the arm and in the ankle. A reading under one indicates narrowing of the blood vessel. Donna Mendes, M.D., chief of vascular surgery at St. Luke's Hospital in New York City, also suggests checking the pulse in the groin, behind the knees, and in the leg.

5 Stress test--provides information on how the heart responds to exertion. It involves walking on a treadmill or pedaling a stationary bike at varying levels of difficulty while heart rate and blood pressure are monitored.

Because of the underrepresentation of blacks in heart disease studies, the FDA has mandated greater minority inclusion in clinical trials. Now there are several medications that mitigate the multiple risk factors. One recent trial on heart failure shows that a fixed dose of isosorbide-dinitrate in combination with hydralazine decreased heart failure mortality and increased quality of life. Other medications currently available are designed to raise HDLs (good cholesterol) and lower plaque. Other medications that can help:

6 Beta blockers lower blood pressure, treat chest pain, and assist in the recovery of heart attack survivors and increases survival rates in patients with heart failure.

7 ACE inhibitors and angiotensin receptor blockers lower blood pressure and are very effective in the treatment of heart failure and renal disease. ACE inhibitors also increase blood flow, which helps to decrease the amount of work the heart does.

For other medications, medical procedures, and prevention tips, go to www.black-enterprise.com