“Despite our nation’s advances in science, public health, and healthcare, the health status of the African-American community continues to lag behind the general population,” states the OMH website. “The OMH is working to reduce disparities and promote better health for African Americans.” Among OMH events this month is a February 20 Twitter chat with the National Heart, Lung, and Blood Institute (NHLBI) and the American Heart Association highlighting the risk factors of heart disease among African-Americans. “High blood pressure affects nearly half of African-Americans, yet many are unaware that they have the condition,” says Sarah Samaan, MD, a cardiologist with Baylor Scott & White Legacy Heart Center in Plano, Texas. Similarly, “sickle cell disproportionately affects African-Americans, and that’s why it’s important to stress awareness this month,” says Traci Mondoro, PhD, a branch chief with the NHLBI’s division of blood diseases and resources. OMH provides reports and statistics about health disparities by race and ethnicity, as well as a searchable database at HealthyPeople.gov. A sickle cell disease website offers information, resources, and personal stories for people living with the blood disorder.
Heart Disease: The No. 1 Killer
Heart disease is the leading cause of death among all Americans, according to the American Heart Association. The Centers for Disease Control and Prevention (CDC) estimates that 23.8 percent of heart disease deaths each year are among African-Americans. The CDC reports that almost 44 percent of African-American men and 48 percent of African-American women have cardiovascular disease, including heart attack and stroke. One of the major contributors to heart disease is high blood pressure, or hypertension. “African-Americans tend to suffer high blood pressure at higher rates than other ethnicities,” says Dr. Samaan. “Salt sensitivity is more likely to be an issue among African-Americans, and there is good evidence that a typical Southern diet, heavy on fried and processed food and high in sugar, correlates with risk for hypertension, high cholesterol, diabetes, and obesity,” says Samaan. “All of these conditions can lead to heart disease and stroke, as well as other chronic health conditions like arthritis, dementia, and lung disease.” The good news is that most cardiovascular-related deaths can be prevented. The CDC advises that people mind their “ABCS”:
A — Take aspirin as directed by your healthcare provider.B — Control your blood pressure.C — Manage your cholesterol.S — Don’t smoke.
If diet and exercise are not enough to control hypertension, there are many types of prescription blood pressure medications, or antihypertensives. According to the American Heart Association, thiazide-type diuretics (water pills) and calcium channel blockers (CCBs) have proved to be more effective in lowering blood pressure in the African-American population. A review of 55 studies published in May 2013 in the journal BMC Medicine suggests that this may be due to a genetic sensitivity to certain medications. Samaan says that patients often need to be educated about the relatively low risks associated with taking these medications. “Many people are afraid of the potential side effects of blood pressure meds, but it’s important to understand that the majority of people will not experience problems with medical therapy,” she says. “If side effects do occur, there are usually several other options to choose from.”
Sickle Cell: An Inherited Blood Disease
Another major health concern in the African-American community is sickle cell disease, or sickle cell anemia, an inherited blood disorder. The disease is caused by a genetic mutation that results in sickle- or crescent-shaped red blood cells rather than normal dome-shaped cells. Sickle cells are stiff and sticky, and can block blood flow in vessels to the limbs and organs. These cells also have a shorter life span, which leads to a shortage of red blood cells (anemia). The hallmark symptom is pain. “A lot of sickle cell patients have pain in their limbs or when trying to breathe,” says Dr. Mondoro of NHLBI. “You don’t know when it’s coming or what’s going to exacerbate it.” People with sickle cell disease are also at high risk for stroke. “These strokes can start as early as kindergarten,” Mondoro says.
Current Treatment Options and New Research
Approved by Food and Drug Administration in 1997, the drug Hydrea (hydroxyurea) has been shown to reduce painful episodes and complications by decreasing the number of sickle cells in the body. In 2017, Endari (L-glutamine oral powder) became available to reduce acute complications from sickle cell. The only proven cure for the disease is a bone marrow transplant, which can be complicated and risky. “There are reasons why everyone’s not lining up to do this,” says Mondoro. “First of all, you need a bone marrow donor matched to you, and that’s very often difficult to find. Plus, transplants are very expensive and it’s a lengthy process that’s very draining.” Scientists are developing and testing new treatments, including gene therapies, which are showing great promise for managing or curing sickle cell. “This is an exciting time because there are more than 31 agents in clinical trials now for sickle cell disease,” says Maureen Achebe, MD, a hematologist at Brigham and Women’s Hospital in Boston. “Many of these treatments have the potential to manage the disease the way that hypertension can be managed. There is a sense that we can do something really significant about the disease.” The outlook for sickle cell patients has improved dramatically since the 1970s, when the life expectancy was under age 20. The average life expectancy has risen to 42 to 47 years old, according to the American Society of Hematology, and Dr. Achebe estimates that it may be even higher — between 58 and 62.
Education, Advocacy, and Access to Care
For Mondoro, educating people about symptoms, treatments, and ongoing research makes the biggest difference in helping those who have sickle cell. The Sickle Cell Information Center provides a comprehensive list of organizations that are dedicated to assisting those who have the disease. “Awareness is on the rise, but we encourage people who have sickle cell or know people who have sickle cell to try to advocate in any small or large way that they can so there will be more compassion and understanding about the disease,” says Mondoro. Achebe adds that the biggest obstacle is access to care. “The opportunities to access good care for sickle cell disease vary in different parts of the country,” she says. “In many parts of the United States, access to a hematologist is difficult if not nonexistent. Efforts to link primary care physicians with hematologists and other strategies to connect more patients to care should produce better results.”
