Perceived Racism Linked to Significantly Increased Risk for Heart Disease in Black Women

Shanshan Sheehy, ScD

Among a large cohort of Black women, self-reported interpersonal racism in employment, housing, and interactions with law enforcement was associated with a 29% higher risk of coronary heart disease (CHD), according to authors of a new study.

Study findings were based on data for more than 48 000 women participating in the Black Women's Health Study, the largest US study of its kind on the health of Black women, according to an AHA statement. Investigators presented their results at the American Heart Association’s (AHA) Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023.

"Many Black adults in the US are already at higher risk of developing heart disease due to high blood pressure or type 2 diabetes," said lead study author Shanshan Sheehy, ScD, in the statement. Sheehy is an assistant professor at Boston University's Slone Epidemiology Center and Chobanian & Avedisian School of Medicine.

"Current evidence shows that racism may act as a chronic stressor in the human body, and chronic stress may lead to high blood pressure, which increases the risk of heart attack and stroke."

Sheehy and colleagues followed 48 297 women participating in the Black Women's Health Study from 1997 until the end of 2019, according to the study abstract. Participant age ranged from 22 to 72 years and all were free of cardiovascular disease and cancer in 1997.

At study enrollment participants provided information on perceived interpersonal racism, answering 5 questions about their experiences in everyday activities, such as "How often do people act as if they think you are dishonest?" An additional 3 questions asked if they had ever been treated unfairly due to their race in circumstances of employment, housing, or interactions with police.

Averaging participant responses to the first set of 5 questions, the researchers calculated a score for self-perceived interpersonal racism in everyday life and divided participants into quartiles according to their scores. They calculated a similar perceived racism score based on answers to the 3 questions on interactions involving jobs, housing, and police interactions with values ranging from 0 (no perceived interpersonal racism) to 3 (“Yes” to all 3 questions). According to the study abstract, the team used Cox proportional hazard models to assess the association between perceived interpersonal racism with incident CHD, adjusting for potential confounding variables.

FINDINGS

During a follow-up period of 22 years, Sheehy et al identified 1036 incident cases of CHD. Among them, women who reported experience of racism in employment, housing, and the criminal justice system had a 29% increased risk (hazard ratio [HR] 1.29, 95% CI, 1.03-1.63, P_trend=.05) of CHD relative to those who reported no such perceived racism. Investigators also report a 21% increased risk of incident CHD for those women in the highest quartile of perceived interpersonal racism in daily life (HR, 1.21, 95% CI, 0.99-1.48, P _trend=.05), compared to women in the lowest quartile.

“Structural racism is real — on the job, in educational circumstances and in interactions with the criminal justice system,” said co-author Michelle A. Albert, MD, MPH, president of the American Heart Association, professor of medicine at the University of California at San Francisco, Admissions Dean for UCSF Medical School, in the AHA statement. “Now we have hard data linking it to cardiovascular outcomes, which means that we as a society need to work on the things that create the barriers that perpetuate structural racism.”

The authors note study limitations that include the observational design, leaving the findings vulnerable to confounding, and the use of self-perception as the measure of racism and collection of data at only 1 time.

"These findings support the hypothesis that experiences of racism may explain some of the disproportionately high incidence of CHD in the Black population,” authors conclude in the abstract. They add that future research is needed to "evaluate the joint impacts of perceived interpersonal racism and structural racism."

Reference: Sheehy S, Brock M, Palmer JR, et al. Association between perceived interpersonal racism and incident coronary heart disease among Black women. Abstract presented at American Heart Association’s (AHA) Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023. February 28-March 3, 2023; Boston, MA. Abstract #P406