Chronic Stress and Heart Disease Risk in Black People

Many Black Americans experience high levels of stress. This may be due to racism, prejudice, institutional inequities, income inequality, and unfair treatment in school, healthcare, and workplace environments.

Chronic stress can deteriorate your health over time, and sometimes its damaging effects are only noticed after it’s too late. 

Cortisol is the main stress hormone in the body, governing the fight or flight response when you feel like you are in danger, as well as a plethora of bodily functions including mediating the stress response, immune function, metabolism, and inflammatory response. Increases in cortisol are helpful over a short period of time, but high levels over a long period of time can heighten blood cholesterol, triglycerides, blood sugar, and blood pressure to increase the risk of heart disease over time.

This article addresses how stress affects heart disease risk in Black people.  

Race, Racism, and Stress

Stress can come from many different sources, including the effects of racism.

Prevalence 

Race is a human-derived social construct used to categorize people.

While the concept of race and the classification of people based on physical characteristics has been around for centuries, this idea that a discrete group of people can be defined by specific genetic and biological differences has been used as a tool to marginalize, oppress, and even abuse certain groups of people over the other.

The trauma of events like slavery, coupled with institutional racism continues to negatively impact Black people to this day.

A recent Kaiser Family Foundation poll found that over 70% of Black Americans report having experienced some form of racial discrimination or mistreatment during their lifetimes—with nearly half saying that they felt that their life was in danger at some point in their life because of their race.

Even more, Blacks were much more likely than Latinx and White respondents to report feeling like they have been denied a job for which they were qualified (40%, 15%, and 8%, respectively) or denied housing they could afford due to their race (26%, 8%, and 3%, respectively).

Stressors Can Be Race-Related 

Racism is a special kind of stress that impacts many Black, Indigenous, and other people of color, but especially Black Americans.

Exactly how the stress of racism deteriorates health remains a mystery, but new research finds that repeated exposure to discrimination and systemic inequity is associated with the biological aging of the cells.

The genetic changes that lead to aging and lower functioning cells is a phenomenon called biological weathering and its impact comes as a result of repeated exposure to:

• Socioeconomic adversity
• Political marginalization
• Racism
• Perpetual discrimination

Another study found that anticipating prejudice can lead to cardiovascular stress responses, which can also increase the risk of heart disease in Black people.

Why Stress Is a Risk Factor for Heart Disease 

The effect of stress is frequently underestimated.

Stress can be caused by financial troubles, divorce, loss of a loved one or chronic illness.

Chronic stress increases the cortisol, which raises your blood pressure and lowers your HDL (good cholesterol).

Chronic stress is also associated with many health-compromising behaviors that may affect your heart in a more indirect way. When you’re worried, you tend to:

• Sleep poorly
• Exercise less
• Make poor food choices
• May not watch your weight

These lifestyle changes put your heart health at increased risk.

Underlying Cause of Chronic Stress Disparities

Some of the most common chronic stressors associated with health disparities include:

• Perceived discrimination
• Neighborhood stress
• Daily stress
• Family stress
• Acculturative stress (stress the occurs when one culture comes into contact with another culture)
• Environmental stress
• Maternal stress

Current research shows that these stressors are more commonly experienced by Black people and lead to chronic stress in addition to long term feelings of hurt and hopelessness. 

Social determinants of health—such as education, access to quality care, neighborhood safety, and proximity to pollution to name a few—... impact health and well-being and play a role in race-based differenced in health.

Discussing Stress With Your Healthcare Provider

It is more important than ever to know how to discuss stress with those that may have the power to help you change it—namely, your provider.

Finding a provider that you trust and respect opens the door for an honest and open discussion about the best ways for you to cope with your stress and implement heart-healthy lifestyle changes. 

Finding a Trustworthy Provider 

Seeking out empathic, equitable, and unbiased medical care as a Black person in the United States takes time, attention, and intention.

Many Black people report that they are more likely to feel comfortable with Black healthcare providers and more likely to adhere to certain preventive measures delivered by Black healthcare providers.

While Black healthcare providers are more likely to practice in underserved communities—often concentrated in urban areas—more rural areas may have few if any.

As of 2018, 5.4% of physicians identified as Black despite Black Americans making up 13.4% of the U.S. population.

For many Black people, finding a trustworthy provider is often centered around finding a Black provider, period. That alone raises the chances you might get the quality of care you need.

A history of biased and substandard care from White providers is one reason why Black people are more trusting of Black providers.

Black providers are also more likely to provide culturally specific care.

Questions to Ask

Choosing the right healthcare provider isn’t easy. It requires you to ask many important self-reflective and open-ended questions to yourself and the office staff to ensure that they are right for you. 

Some introspective questions you might ask yourself include:

• How far am I willing to travel to see my provider?
• How important is it that my provider looks like me? Will a healthcare provider who does not look like me but provides culturally competent care suffice?
• How does this healthcare provider fit into my schedule? Do they have after-hours services?
• What kind of healthcare provider am I looking for?
• I really like this healthcare provider, but they do not take my insurance. Am I willing to pay out of pocket?

Some question you may want to ask your healthcare provider directly include:

• Have you worked with Black people before? 
• What does culturally competent care mean to you? How do you ensure that your care is culturally competent?
• Do you provide genetic testing?
• How long is a typical appointment?

You may also want to ask the staff and other people who have previously worked with your potential provider about their experience. While you cannot, and should not, base your decision solely on the opinion of others, sharing what you know can add perspective to this very important decision. 

An Integrative Treatment Approach

Identifying the underlying cause of your stress and addressing it is the single most important measure you can take to mitigate your heart disease risk.

The following are the components of an integrative approach that addresses the many factors that contribute to your stress.

Medication

Any illness—whether mental or physical—can cause stress and maladaptive changes in the body.

Some of these conditions—like heart disease, diabetes, depression, or anxiety—can be made better with the help of medication.

Medication use is sometimes taboo in the Black community but research shows that using medication as prescribed by your healthcare provider can help manage your underlying health conditions and is a great way to alleviate stress and promote healing.

Therapy 

Black people are just as likely as any other group to experience mental illness. Oftentimes mental illness stems from stress and the constant need to fight against oppressive systems. Mistrust in the healthcare system, mental health stigma, and lack of access to care are only a few of the reasons why only half of Black adults with mental illness get treatment.

A professional therapist can help you to understand what feelings are typical for your circumstances and offer strategies to support your immediate and long-term needs.

Therapy sessions also give you a safe space to get things off your chest and the added benefit of not only helping you to understand yourself better but also understanding other people. You may not feel the positive impacts of therapy immediately, but over time many people come to consider therapy as a powerful tool and a gift that you give yourself.

Lifestyle 

Healthy habits protect you against stress you haven't even experienced yet. Making lifestyle changes aimed at curbing overwhelming levels of stress is a part of any comprehensive stress relief plan.

Finding healthy ways to calm down not only helps you to avoid the negative effects of chronic stress, especially indolent conditions like type 2 diabetes and high blood pressure that silently damage the heart, but also brings added health benefits like the release of endorphins that heighten brain and body function.

The following healthy habits may greatly prevent or reduce your stress, protecting your heart in the process:

• Regular exercise
• Eating a heart-healthy diet
• Never smoking and limiting alcohol
• Getting quality sleep
• Enjoying activities and talking with supportive groups of friends and family

Stress Management 

Taking breaks at work, talking to supportive friends, eating healthy, and going for a run after work or school are some ways that you can manage your stress.

The goal isn’t to avoid stress at all costs—that’s nearly impossible to do—but to find ways to address stressful situations in a healthy way and limit the amount of negative stress that you experience in your life.

Resources

There are many resources you can tap into to help you manage stress in your life. Some options are listed below.

Support Groups

Whether you’re seeking support for coping with an illness, a new diagnosis of heart disease, caregiving, depression, or simply trying to overcome the uneasiness of your current situation, attending a support group can be a valuable step toward healing.

The Association of Black Cardiologists specializes in the prevention and treatment of cardiovascular disease in Black people and has created Mended Hearts, a support group that sets out to inspire hope and improve the quality of life of people with heart disease and their families. 

Finding a local support group may be the first step in your journey towards recovery. Many other local support groups exist, providing immense value to many Black people who are in the midst of the healing process. Attending these sessions with openness and a positive spirit are integral to getting the most out of this experience, but it’s important to note that everyone’s healing process is different, so take your time and move at your own pace. 

Family and Peers

Family and friends are great sources of social support. These are the people who know you the best and can understand what you’re going through.

Sometimes you may feel like you have the weight of the world on your shoulders but stress is made worse when you bottle it up inside. Talking things out with people you trust is a good way of getting things off your chest and not freeing your mind of negative thoughts that can eat away at your health. 

Summary

Black people are disproportionately impacted by stress and stress-related disease due to systemic inequality. High levels of cumulative stress put many Black people at high risk of heart disease which can lead to heart attack and stroke. 

A Word From Verywell 

Chronic stress can stem from poverty, a dysfunctional marriage or family, or a deeply dissatisfying job, but the causes are truly endless. Limiting stress and living a healthy lifestyle are surefire ways to lower your heart disease risk. The importance of taking every measure possible to curb stress cannot be understated, especially in Black communities that have been historically marginalized.