Black people in the United States have lower rates of heart disease than white people. But they tend to develop it earlier and have worse outcomes. Socioeconomic factors and higher rates of underlying conditions play a role in this disparity.

an older African American adult in front of a kitchen window with their hand on their chestShare on Pinterest
FG Trade/Getty Images

“Heart disease” is an umbrella term for a wide range of conditions that affect your cardiovascular system. It’s the leading cause of death in the United States and across the world.

According to the Centers for Disease Control and Prevention (CDC), heart disease-related deaths have decreased since 1999. Still, Black people in the United States are more likely to experience complications or die from heart disease than people of other racial backgrounds.

Black people also tend to develop symptoms of heart disease at an earlier age than people of other races. So, while Black people in the United States tend to have lower rates of heart disease overall than white people, it may pose a greater risk to their health.

There are many reasons for this disparity, and several of them are connected. This article takes a deeper look at some of those reasons and what African Americans can do to prevent or manage heart disease.

The most common type of heart disease in the United States is coronary artery disease (CAD), also called coronary heart disease. It’s when blockages in your artery affect blood flow to your heart. Although heart disease includes several types, people often use “heart disease” to mean CAD.

According to the Office of Minority Health, about 5.4% of non-Hispanic Black adults in the United States have CAD. That’s slightly lower than the rate among non-Hispanic white adults (5.8%).

But the story is much different when you look at deaths from heart disease. Non-Hispanic Black adults are 26% more likely to die from heart disease than white adults. According to the CDC, they’re more than twice as likely to die than non-Hispanic Asian or Pacific Islander adults.

The disparity is greatest when looking at people under the age of 50. Heart disease is more likely to affect older people. But Black adults under 50 are twice as likely to die from heart disease as their white peers.

There’s no one reason Black people in the United States have worse outcomes from heart disease. Instead, there’s a complex web of factors that often influence each other. Here are some of the key factors:

Underlying conditions

Perhaps one of the most direct reasons for poorer outcomes among African Americans is the higher rate of underlying conditions that contribute to heart disease. These include:

Not only are these conditions risk factors for developing heart disease, but they also increase the risk of complications.


Your genes may contribute to your risk of heart disease. Some genetic lipid disorders are more common among African Americans. These can increase your risk of heart disease.

While more research is needed, studies have identified genes that may be more common in Black populations that can affect your:

  • risk of high blood pressure
  • risk of inflammation that could lead to plaque in your arteries
  • heart structure and function

Lifestyle factors

Several lifestyle factors that contribute to heart disease are more common among African Americans. They include:

  • Lack of physical activity: Overall rates of physical activity are low in the United States, but they are even lower for African Americans. Only 1 in 5 Black men and 1 in 8 Black women get the recommended amount of exercise each week, reports the American Heart Association. They also spend more time than white people sitting.
  • Diet: Regardless of where they live, African Americans are more likely to consume a “Southern diet” high in added fats, sugars, and sodium.
  • Smoking: African American men smoke at higher rates than almost any other racial group. According to the CDC, tobacco companies often target their marketing of menthol cigarettes to the Black community. People who smoke menthol cigarettes have a harder time quitting.

Healthcare factors

Black people in the United States face several barriers to quality healthcare. These include:

  • Access: Predominantly Black neighborhoods are more likely to lack access to hospitals and other care centers. Black people are also more likely to be uninsured or underinsured, making treatment or preventive care cost prohibitive.
  • Quality: Even when care is available, the quality is often lower. This could be due to what’s available in the area or the effects of racism on patient care.
  • Patient-clinician relationship: There are often cultural barriers that can affect the relationship and quality of communication between you and a healthcare professional. This can affect your quality of care.
  • Adherence to medication: Black people are less likely to have underlying conditions, like high blood pressure, under control, often due to not taking medication as prescribed. Communication problems between healthcare professionals and patients, medical mistrust, and costs can contribute to this.

Social determinants of health

Many nonmedical factors can influence your health outcomes. These are known as social determinants of health. They can influence your ability to manage underlying conditions or make positive lifestyle and dietary changes.

Examples include:

  • income
  • job stability
  • where you live
  • available transportation
  • level of education
  • systemic racism

But even African Americans with higher education and more resources are still subject to poorer outcomes when it comes to heart disease. This underscores the impact of systemic racism and the complex set of factors at play.

CAD is the most common type of heart disease that affects African Americans. But there are other types you may encounter. They include:


Arrhythmia is an irregular heart rhythm. There are several types of arrhythmias. One of the most common is atrial fibrillation (AFib).

African Americans are much less likely to have AFib than white Americans but are more likely to experience complications.


Atherosclerosis is the buildup of plaque in your arteries, causing them to narrow. It often leads to CAD. Some research suggests that young Black people may be at higher risk than some other groups.


Cardiomyopathy causes your heart muscles to harden or weaken. While there are many types, dilated cardiomyopathy seems to disproportionately affect African Americans: They are twice as likely to develop it and up to five times as likely to die from it. The reasons for this are unclear.

Hypertrophic cardiomyopathy is the most common inherited heart condition. Black people tend to have symptoms earlier in life and are less likely to receive appropriate treatment.

Recent research also discovered a gene common in African Americans that could cause amyloid cardiomyopathy, leading to heart failure.

Congenital heart disease

Some people are born with structural irregularities in their hearts. Black people are 31% more likely to die from congenital heart disease than white people.

Heart valve disorders

African Americans have higher rates than white Americans of risk factors for heart valve disorders. But according to the Association of Black Cardiologists, African Americans are 54% less likely to be offered treatment than white people. They’re also 33% less likely to accept treatment when offered.

Peripheral arterial disease

Peripheral arterial disease (PAD) isn’t a heart disease, but it is a cardiovascular disease. Instead of the arteries in your heart being blocked, it’s the arteries in your legs. This can also lead to events like heart attack or stroke.

African Americans have a greater lifetime risk of PAD than other racial groups.

You can take several steps to lower your chances of developing heart disease.

Know your risk and family history

Having a family member with heart disease increases your risk of developing it. It helps to know your family history, if possible, and to take precautions early. It also helps to be aware of risk factors you have or that also run in your family.


Several tools are available to help you detect heart disease early. Consider the following:

However, note that some tools meant to detect heart disease early tend to underestimate prevalence in Black people.

Look for warning signs

Symptoms to look out for include:

Stay active

Try aiming for 150 minutes of moderate activity each week. If you live in an area where that’s difficult, try finding ways to exercise at home.

Manage your weight and diet

Excess weight increases your risk of developing heart disease and experiencing complications. Regular activity will help you maintain a moderate weight.

But a heart-healthy diet is also a positive step. Limiting your salt intake can help reduce your blood pressure and can have a big impact.

Take your medications

It’s important to manage underlying conditions, too. That means taking medications as prescribed and checking your blood sugar levels when you need to.

Big-picture changes

While there’s much you can do on your own, we still need to work toward some systemic changes. We can’t address issues of access and social determinants of health on our own.

We can (and should) advocate for policy changes that increase access to care, nutritious food, and safe spaces for activity. Experts also promote the efforts of community partnerships that aim to eliminate barriers, like providing transportation to older adults or free clinics.

The effects of heart disease

Without proper management, heart disease can lead to:

  • Heart failure: Heart failure occurs when your heart can’t pump enough blood to keep your organs working.
  • Heart attack: When blood flow to your heart is cut off, a heart attack occurs. Its medical term is myocardial infarction.
  • Stroke: Similar to a heart attack, a stroke occurs when blood flow to your brain is cut off.
  • Cardiac arrest: Cardiac arrest is when your heart stops beating.
Was this helpful?

If you have some form of heart disease, your treatment will depend on the specific type. Treatment options are usually the same regardless of race, but there are a few exceptions.

Earlier research suggested that African Americans may have a different reaction to certain types of common heart medications, with some experts recommending alternative treatments. However, these studies had such a small sample size of African Americans, it was unclear whether a different treatment approach was warranted.

New research suggests that race-based treatment guidelines have not improved outcomes in the Black community. Researchers suggest an individualized approach to treatment is more effective than following guidelines based on race.

More important factors to consider include:

  • dosage
  • additional therapies
  • medication adherence
  • dietary and lifestyle changes

Talk with a doctor about what treatment may be best for your circumstances.

Heart disease is a major concern for many Americans, especially African Americans. While outcomes for white people have improved a lot over the last few decades, Black people have not seen the same improvements.

Given the disparities, it’s important for African Americans to manage any risk factors within their control. This includes managing your blood pressure, treating diabetes, and maintaining a moderate weight.

Even if you do develop heart disease, it’s still possible to live a long and healthy life. Many of the steps you take to prevent heart disease can help you manage the condition.