Isosorbide dinitrate

FOR years, Shirley Lytle considered herself the picture of health. She was a healthy nonsmoking professional who ran up to 4 miles three days a week, and practiced healthy eating habits.

Then one day, the unthinkable happened. Her doctor told her that she had coronary heart disease and that she could die of a heart attack if she didn't undergo bypass surgery immediately. She was just 31 years old.

The Phoenix resident, now 43, had a successful operation, but for the rest of her life she will have to contend with coronary heart disease, a condition she inherited from the maternal side of the family.

Shirley Lytle is not alone. Nearly 4 in every 10 non-Hispanic Black adults have cardiovascular disease, according to the American Heart Association. This includes diseases of the heart, stroke, high blood pressure, congestive heart failure, congenital cardiovascular defects, hardening of the arteries and other diseases of the circulatory system, the association says.

Cardiovascular disease is the No. 1 killer of African-Americans, claiming the lives of 37 percent of the nearly 288,000 Blacks who die each year, according to the association. Risk factors include smoking, high blood pressure, diabetes, high cholesterol, obesity, stress and lack of exercise. Doctors say people have no control over some factors, including age, gender and family history.

While the disease strikes African-American men and women alike, it is particularly deadly for Black females, with 5 in every 10 dying each year of cardiovascular diseases, says Dr. Lynne Perry-Bottinger, a New York interventional cardiologist.

The reason is a clustering of risk factors, like diabetes, hypertension and obesity, in African-American women, says Dr. Anne L. Taylor, a professor of medicine at the University of Minnesota and director of the Association of Black Cardiologists' Women's Center, who edited and co-authored the recently released book, The African American Woman's Guide To A Healthy Heart.

The cause of the disease's deadly effect on African-American women is unclear, but it is believed to be related to genetics, environment and disparity in medical care, doctors say. Studies also show that the risk for cardiovascular disease increases in post-menopausal women. "If you go to the doctor and they make assumptions based on your race or gender, you may be deprived of care," Dr. Taylor says. "African-Americans, especially women, are less likely to be referred for rehabilitation and diagnostic care. We have to educate the community about who's at risk and what they can do about it."

Cardiovascular disease knows no socioeconomic or educational bounds and can touch the lives of everyone, including high-profile performers like Toni Braxton. The singer was recently diagnosed with pericarditis, an inflammation of the pericardium, a thin lining of the heart. Her diagnosis and the experience of seeing several family members suffer or die from the disease led Braxton to become the American Heart Association's official spokeswoman for the association's "Go Red for Women" campaign, an initiative designed to help fight heart disease in women.

The staggering number of heart disease deaths in the Black community has set off an alarm throughout the medical community, generating studies like the so-called "African-American Heart Failure Trial." The study of 1,050 Black patients found that a combination of two rarely used heart drugs, isosorbide dinitrate and hydralazine, cut the annual death rate of African-American heart failure patients by 43 percent and contributed to a 33 percent reduction in first-time hospitalizations.

Some critics described the study as medical profiling since it merely focused on African-Americans. But experts like Dr. Paul Underwood, a Phoenix interventional cardiologist, who is the president of the Association of Black Cardiologists (which co-sponsored the study), called the results significant, saying that Blacks traditionally have been underrepresented in clinical trials.

"The significance of the study is that in the past we had to assume that medicines that were good for the majority were good for African-Americans," Dr. Underwood says. "By reanalyzing the small number of African-Americans in these trials, we may have different information. The clinical trial has opened up new possibilities in the treatment of cardiovascular diseases in African-Americans."

The best weapon African-Americans have to help combat cardiovascular disease is education, which leads to preventative care and rapid intervention, as Shirley Lytle of Phoenix learned. Patients need to learn the symptoms so that they can demand better care from medical professionals, doctors say. And many need to change their lifestyles to incorporate exercise in their daily lives, eat healthy diets and train their children to do the same, doctors say.

"After I was diagnosed, I changed my lifestyle and that of my family," Lytle says. "I exercised at the gym two hours a day. I changed my eating habits and took salt out of the house. There was nothing resembling bacon in my refrigerator. What I thought I was doing was trying to beat heart disease. I wanted it to be like eradicating cancer. Then I realized it was a lifelong effort, one which I am committed to."

COPYRIGHT 2005 Johnson Publishing Co.
COPYRIGHT 2005 Gale Group