Cardiovascular Disease in African American Population
Recent medical studies indicate that cardiovascular is the current killer disease that claims several lives across the world. The disease has wreaked havoc in the health sector for a very long time despite the intervention techniques of treatment and control (Mensah & Brown, 2007, p. 39). With the current prevalence rate of the cardiovascular disease among the African-American population, there is a need to develop an understanding of the disease to facilitate the development of appropriate intervention methods. Therefore, this paper evaluates the ways through which cardiovascular disease can be treated or controlled based on the prevailing health condition of the selected population. Medical practitioners can only achieve efficient treatment of cardiovascular through a thorough research to ascertain the efficiency of the present treatment and prevention methods.
Cardiovascular Disease (CVD) is a medical condition that affects the heart and blood vessels. The most common CVDs are the coronary artery diseases that include angina and myocardial infarction, which is also known as heart attack (Lim, et al., 2013). Other cardiovascular diseases include stroke, venous thrombosis, rheumatic heart disease, cardiomyopathy, congenital heart disease, endocarditis, aortic aneurysms, heart arrhythmia, peripheral artery disease, and hypertensive and heart disease. CVD has a range of causes varying from high blood pressure 13%, smoking of tobacco 9%, diabetes 6%, lack of exercises 6%, and obesity 5%.
Apart from silent coronary heart diseases (CHD), cardiovascular diseases have a series of signs and symptoms (Mensah & Brown, 2007, p. 46). These include (a) angina – which is chest pain caused by lack of adequate oxygen supply to the heart muscles (b) heart attack that is characterized by chest pain and discomfort around the upper arm. Heart attack occurs when a clot on a blood vessel cuts of blood flow to a particular part of the heart. If the clot cuts off the blood flow completely, the part of the heart that served by that blood vessel dies off leading to sudden death. (c) heart failure that is characterized by short breath and fatigue, swelling of feet, ankles, and the neck veins (d) arrhythmia that is characterized by variations in the rhythm of heart beat. In this case, the heart may beat too fast, too slow, and irregularly. The condition may also cause the heart to suddenly stop pumping, a condition referred to as sudden cardiac arrest (SCA) and this may lead to unconsciousness or sudden death.
The 2014 report by the World Health Organization (Table 1) indicated that cardiovascular disease is the leading cause of deaths worldwide with the number of deaths hitting 17.6 million (31.5%) in 2014 compared to the 12.3 million (25.9%) in 1991. The increase in the number of deaths indicates that the cardiovascular disease is contagious and poses a bigger threat to humanity. In the United States, heart disease accounts for up to 25% of the total annual deaths. According to the 2015 reports released on the country’s health statistics (Table 2), 44% of the African-American men and 48% of African-American women suffer from cardiovascular disease (Bidulescu et al., 2013).
|Number of global deaths||Percentage||Cause of deaths|
Source: World Health Organization, 2014
|Affected group||Deaths by percentage|
Current surveillance methods
Surveillance is an ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality while improving the health of the population (CDC 2010). Routine surveys are the most appropriate methods of surveillance for cardiovascular diseases because the methods help the surveyor to obtain the most valid data from the people affected. With the information about routine surveys, this section of the paper considers some of the surveys carried out in the United States including their purpose, methods of data collection, and the dissemination of data and information.
- The Behavioral Risk Factors Surveillance System (BRFSS)
BRFSS is a state based system of cross-sectional health surveys of adults. The method is used to collect the information concerning the health risk behaviors, health care access, and preventive health practices. BRFSS is coordinated by CDC and co-funded by the state. The BRFSS has been pivotal in providing the state with information since 1984. The BRFSS submit the information and data files via a website http://.cdc.gov/brfss/ and any other additional survey instrument that is deemed fit (Fuster, Kelly & Vedanthan, 2011). One very important strength of BRFSS as a source of health data is that the CDC is in control over the survey questions to be used in data collection. BRFSS therefore gives reasonable data compared to other states.
- Youth Risk Behavior Surveillance System (YRBSS)
The YRBSS is coordinated by CDC and the state. The method is aimed at monitoring the health risk behavior including activity and prevalence of obesity among school going children between 9th and 12th grades. The YRBSS basically monitors the six categories of health risk behaviors among the youth and adults which pertains CVD risk factors. The information obtained is used to evaluate the community-based programs and is applied in policy development for national research and surveillance of health risk disparities. YRBSS posts the information to the website www.cdc.gov/yrbs, enabling the information to be accessed by the general public. The main strength of this method is that it ensures that the data collected is comparable to the ones collected by other states.
- New York City ( NYC) Community Health Survey(CHS)
This is a local surveillance mechanism started in 2002 and is used to collect information on the health risk behavior; health condition, preventive health practice, and health care access in relation to chronic diseases, such as cardiovascular diseases(Zhang, Fu & Gao, 2014) . NYC, CHS is solely funded by the NYC Department of Health and mental hygiene. The annual report is posted on the website for every person to read and take appropriate preventive measures.
Health surveys generally provide information to the general population and the state about the prevalence of and distribution of chronic diseases and the associated risks behavior that may lead to them and their possible consequences. Providing the state government with this information enables it to come up with way to counter these diseases and improve the healthcare of the general public.
- National Health Interview Survey (NHIS)
The NHIS is a federal funded survey conducted by the National Centre for Health Statistics, which provides data that are used to monitor trends in illness and disability in attempt to achieve the health objectives for determining barriers to accessing effective heath care in the USA. The information obtained is used to identify the high risk individuals so as to take precautionary measures to assist them. The NHIS also post its finding to a web page for the members of public and health practitioners to access.
Descriptive Analysis of Cardiovascular Disease
According to a study funded by the National Heart, Lung and Blood Institute (NHLBI), approximately 16.3 million Americans aged 20 and older have coronary heart disease (CHD) a prevalence of 7 percent. The prevalence for men is 8.3 percent 2.2 percent more that the prevalence in women which stands at 6.1 percent (Chopra & Peter, 2012). CHD include heart attack and angina. In the U.S population, 7.9 million people have suffered heart attacks while 9million persons suffering angina. This data show that the prevalence of heart attack among the Americans adults age 20 years and older is 3.1 percent. It is more prevalent in men than in women, meaning that it is more likely for a man in America to suffer heart attack than a woman.
A study carried out by the Public Health Department in two states in America revealed that cardiovascular diseases are prevalent among the African-Americans than among the Africans or Americans living in the USA. The study was carried out to examine the risk factors among the African-Americans residing in the US Virgin Islands (USVI) and compared to the risk factors among those residing in Washington DC (Fuster, Kelly & Vedanthan, 2011). The researchers found out that the African-Americans residing in Washington DC have a greater prevalence of reported cases of CVD than those residing in USVI accounting for sex, age, education, and health behavior. The high risk factor of CVD among the African-Americans in Washington DC is attributed to their heath behavior, as majority of individuals are characterized by conditions, such as obesity, high blood pressure, and diabetes. The study also indicated that that African-Americans residing USVI have better health practices than their counterparts in Washing DC despite having lower education and income. This suggests that social and physical factors influence the prevalence of CVD among the African-Americans and it becomes necessary for the population to adopt healthy lifestyle.
Table 3: Age-adjusted prevalence of CVD and risk factors for non-Hispanic black adults >20 years of age among U.S. and USVI residents, by U.S. area of residence: Behavioral Risk Factor Surveillance System, U.S., 2007 and 2009. Source: Public Health Report.
Screening and Diagnosis
Screening for cardiovascular diseases consists of three main phases: a. risk category assignment, b. early disease assessment and c. modified disease contributor assignment (Kirby, 2010). The extent of screening evaluation and cost is based on the risk category assignment. Other test may not be significant in the low risk individuals and therefore may not be valued using the cost – benefit analysis.
Before diagnosing a patient for CVD, it is necessary to conduct an assessment test to establish the patient’s cholesterol level, life style (health behavior), and recent medical history. In the case of a suspected cardiovascular disease, a more elaborate diagnosis is recommended and the patient is, therefore, referred for screening.
There are various screening tests for CVD and echocardiography is the most commonly used for initial imaging test to evaluate CVD relating to functional and structural abnormality of the heart vessels. The test uses beams of reflected ultrasound from the cardiovascular structures to produce characteristics shape caused by normal or altered cardiac structures in a one, two or three dimensions by M- mode, two-dimensional, or three – dimensional echocardiography, respectively (Chopra & Peter, 2012). This gives the structural and functional information about the heart without ionizing radiation or causing patient discomfort. It is also the best-suited technique for initial assessment of cardiac diseases. Apart from echocardiography, other screening tests include electrocardiogram, treadmill testing, coronary computed tomography (CT) angiography, X- rays, and radionuclide tests. Below is a table showing sample results of an assessment test for CHD in asymptomatic population
|Study||n||Entry Criteria||Event Definition||% Follow-Up||Mean Follow-Up, y||Annualized Event Rate, %||Calcium Definition||CAC Prevalence, %|
|Arad et al, 1996 3||1173||Asymptomatic, prior CAD or angina||Cardiac death, MI, thromboembolic stroke, revascularization||99.8||1.6||1.5||Score ≥100||11.8|
|Secci et al, 19974||326||Asymptomatic ≥1 risk factor, no prior MI or angina||Death, MI||90||2.7||1.5||Score >156||50.0|
|Detrano et al, 19992||1196||Asymptomatic with multiple risk factors, no prior MI or angina||Death, MI||99||3.4||1.6||Score >0 (median=44)||68|
(Source: Journal of the American College of Cardiology – JACC)
Plan of action
According to CDC recommendations on preventing and controlling the cardiovascular disease to the world, the following were highlighted: the nations were advised tom develop policies that for preventing heart diseases and stroke at national, state and local levels to assure effective heath action. The action was to include acquiring new knowledge on efficacy and safety of therapies to reduce risk factors. Timely implementation of intervention programs on adequately to permit thorough evaluation and rapid replication and dissemination of those most effective ones.
The second recommendation was to promote cardiovascular health and prevent heart diseases and stroke through interventions in multiple settings for all age groups and for all population especially the high risk groups such as patients with type 2 diabetes. In addition to this, the nations were advised to strengthen public health agencies to ensure that they develop and maintain sufficient cavities and competencies, including their laboratories. Public health agencies at the local levels are to establish specific programs to promote cardiovascular disease prevention.
Furthermore the various governments were to establish training facilities and support training offering the model standard for preventing chronic diseases and make consultation accessible to public health agencies. The CDC also recommended all the countries to develop suitable and highly effective surveillance mechanisms to be used both at the national and the local levels. These mechanisms will ensure that the high risks individuals are detected early enough, screening carried out comprehensively and a suitable action take to suppress the disease.
A part from the recommendations by the CDC, various countries have also come up with preventive method both at the national level and the local levels. Some of the prevention and control measures that have been put forward to reduce the impact of cardiovascular disease include: 1) use of clinical decision – support system at the point of care. This is a computer information system that assists health care providers to keep track of specific health information of their patients and hence advising them accordingly in case of any signs of development of CVD. 2) Using team – based care, this consists of a healthcare team that works hand in hand to improve patient care. This helps in sharing information concerning the patient heath among the team from the primary care provider to the pharmacist. 3) Reducing out of pocket costs for the patients. This increases medical adherence by the patients and hence increasing the number of patients visiting health centers.
To add to the existing actions aimed at preventing and controlling CVD, there is still a need to establish a mechanism for carrying out mobile assessments tests. This is a door-to-door initiative that will ensure that cases of CVD are detected early enough and corrective measures taken to prevent severe effects. The members of public from various states should also be educated on healthy lifestyles to reduce cases of CVD resulting from poor health behaviors. They should be advised to always make an effort to visit health centers for regular check – ups that may lead early detection and prevention of any form of cardiovascular disease.
Finally, both the federal and state governments should formulate health policies that encourages compulsory screening for CVDs in all heath centers. This will also give the health practitioners an upper hand in detecting and dealing with such diseases early enough.
In conclusion, this paper has established that CVD is posing a major threat to human populations globally. Following the studies that have been carried earlier, a large number of people are still exposed the dangers of cardiovascular diseases. For instance, medical research indicate that CVD has a range of causes varying from high blood pressure 13%, smoking of tobacco 9%, diabetes 6%, lack of exercises 6%, and obesity 5%. As at present, close to 16.3 million Americans aged 20 and older have coronary heart disease (CHD) with a prevalence of 7 percent. The prevalence for men is 8.3 percent 2.2 percent more that the prevalence in women which stands at 6.1 percent. In the U.S population, 7.9 million people have suffered heart attacks while 9million persons suffering angina. This means that if an urgent action is not taken the number of deaths caused by this disease per year will increase to an imaginable level by the year 2020. It is there important to call upon various stakeholders in the health sectors in various countries to act fast and find a way of dealing with this killer disease. To control the problems resulting from the disease, every individual has to practice a healthy lifestyle to minimize the risk of contracting this disease. This paper also points to the general fact that early screening of cardiovascular can help to reduce the chances of developing the disease.
Contemporary issues in medical research point to the fact that cardiovascular diseases can be prevented or delayed through healthy lifestyles and preventive health care services such as eliminating the use of tobacco. The other way to prevent CVDs is by eating a heart healthy diet that entails eating plenty of vegetables and fruits and avoiding food rich in cholesterol. In addition to these two measures one should also ensure that they physically active to cut down the calories and reduce obesity which is one of the major risk factors of cardiovascular diseases. Having regular check-ups for blood pressure and blood cholesterol also work toward managing the CVD by ensuring that any trace of the disease is identified early enough and dealt with at the right time. Finally, it is importance for every individual to try to manage stress as much as possible so as to reduce their chances of developing CVD. It is also important to note that the healthy lifestyle that prevent cardiovascular disease can help prevent other health problems such as cancer, diabetes, arthritis and depression. Practicing healthy lifestyle therefore comes with double benefits. The parting shot in this conclusion is that preventing cardiovascular disease is and should always be a collective responsibility to the government and also to all the citizens.
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