Because of this, race itself isn’t the end all be all when it comes to heart failure risk. It is in no way as simple as “heart failure is passed on genetically in certain groups,” says Dr. Morris. Here’s why: Since some genetic mutations that are linked to heart failure—such as transthyretin amyloidosis, which can cause a buildup of proteins in the body that can lead to heart failure—are most commonly found in people of African ancestry, it follows that this mutation may be more prevalent in people who self-identify as Black, she explains. But there are many other complex factors at play, including generations of social dynamics, like racism and segregation. “As an African American, I am more likely to have inherited certain traits,” Dr. Morris explains, but that is, in part, because society “kept races apart from each other—intentionally.”
There are also “traditional” risk factors to consider.
“Traditional” risk factors refer to the more common things we know contribute to the risk of heart failure, thanks to evidence gathered in research, says Dr. Khan. For example, we know that high blood pressure is a key risk factor for heart failure—your heart has to work harder if your blood pressure is high, which can stiffen it or weaken it over time, according to the Mayo Clinic. And about 55% of Black Americans have high blood pressure, per the American Heart Association (AHA).
Other conditions and risk factors that fall into this category include having type 2 diabetes; carrying extra weight; not eating enough fruits, vegetables, and whole grains; and being sedentary. These factors can help your doctor evaluate whether you’re at an increased risk of heart failure, Dr. Khan says. And nearly all of them also disproportionately affect communities of color, per the AHA.
Of course, there isn’t a simple explanation as to why high blood pressure, diabetes, and obesity, for example, are so prevalent in Black communities. “It’s very hard to separate the reasons out because they are very interconnected,” says Dr. Khan. Again, some of it may come down to genetics. Additionally, these so-called traditional risk factors are prevalent in communities of color because of societal factors.
Social determinants of health are a big deal.
The term social determinants of health refers to “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks,” per the US Department of Health and Human Services.
Social determinants of health include things like someone’s financial stability, their access to and quality of health care, their ability to find nutritious foods and exercise opportunities in their community, as well as the likelihood of facing racism, discrimination, and violence in their everyday life. In a 2022 paper coauthored by Dr. Khan and published in Clinical Cardiology, researchers note that a variety of social determinants of health have been associated with heart failure risk, including things like a lack of quality education, living in a low-income household or community, living in a region with a poor public health infrastructure, and a lack of health insurance, among others.2
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