Health Disparities in Cardiovascular Disease among Older Adults aged 65+

Introduction

Despite tremendous improvements in health outcomes for cardiovascular diseases
(CVDs) in recent decades, CVDs continue to be the primary cause of mortality and morbidity
worldwide. CVDs, particularly coronary heart disease and cerebrovascular accidents, account for
approximately 32% of global mortality (World Health Organization, 2021). In 2019 alone,
World Health Organization (2021) revealed that roughly 17.9 million people died from CVDs. It
is no different in the United States; it is the country’s biggest cause of mortality. The United
States spends at least $200 billion annually on healthcare services, medications, and lost
productivity due CVDs (Arnett et al., 2019). In spite of significant improvements, African
Americans continue to be disproportionately affected by CVDs, and this disparity persists across
gender. This paper outlines thorough primary preventive strategies for CVDs among African
American men and women aged 65 and above, as well as the socioeconomic barriers in these
communities that impede these health promotion goals.

Significance of Health Problem

CVDs disproportionately impact African Americans compared to other racial groups in
the United States. This disparity arises from several unrecognized and untreated risk factors in
these communities due to their averagely low socioeconomic status resulting in higher CVD
morbidity and mortality. According to Brewer et al. (2019), African Americans are 30% more
likely to die from CVDs than non-Hispanic whites and are more likely to develop a CVD and die
early than their white counterparts. Mensah (2018) further outlines that the significant risk
factors for CVDs such as obesity, hypertension, and diabetes mellitus, and other comorbid
conditions such as sickle cell and chronic kidney have greater prevalence and earlier onset in

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African American men and women than their white counterparts. This problem among African
American population is further worsened by age and gender. Older adults, especially those above
65 years, experience a high prevalence as 75% of them are more likely to develop a CVD.
According to Rodgers et al. (2019), aging African-American women are more likely to develop a
CVD than their male counterparts, a trend observed in other ethnic groups across the country and
attributed to sex hormones.
Unsurprisingly, African-American populations will continue to be overburdened by
CVDs as they still struggle with fewer socioeconomic resources to fight the disease. The major
challenge is that the pervasiveness of CVDs is majorly contributed by the poor implementation
of prevention strategies and ineffective control of CVD risk factors in adults. According to
World Health Organization (2021), 75% of premature CVDs, which is a relatively good figure,
can be prevented successfully by only ameliorating the risk factors. Unfortunately, most African
American adults wait until symptoms of CVDs manifest before finally going for screening while
some do not have access to adequate cardiovascular health care services.
Primary prevention is, therefore, crucial in reducing CVDs morbidity and mortality as it
focuses on addressing the major CVD risk factors such as unhealthy diets, tobacco smoking,
obesity, physical inactivity, and alcohol usage and abuse among African American aging
population (Arnett et al., 2019). Primary prevention involves assessing the future CVD risk
among adults and recommending the best preventive efforts while considering the underlying
social barriers.

Evidence-Based Strategies for Primary Prevention

The most significant way of preventing CVDs is to promote a healthy lifestyle among the
population. Arnett et al. (2019) assert that all the recommendations for a healthy lifestyle should

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be exhausted in the primary prevention of CVD before introducing pharmacotherapy, and this
should only be in cases whereby the person’s risks are sufficiently high.
Heart-Healthy Diet
The first evidence-based recommendation is adopting a heart-healthy diet. To lower CVD
mortality risks, people should adopt Mediterranean and plant-based diets, with an increased
intake of fruits, vegetables, legumes, whole grains, fish, and nuts, and increase their fiber intake.
Foods with high sugar and saturated fat levels should be avoided, and saturated fats should be
replaced with polyunsaturated and monounsaturated fats while avoiding trans fats altogether
(Arnett e al., 2019; Stewart et al., 2020). Reducing the intake of sodium and cholesterol
minimizes cardiovascular risks and hypertension. Other unhealthy foods include red meat, highly
processed meats, refined carbohydrates, and sweetened beverages.
Smoking Cessation
Smoking is a significant risk factor of CVDs and it contributes to 30% of CVD mortality
in the United States (Arnett et al., 2019). Unfortunately, even passive smokers are at similar risks
of CVD. The single most cost-effective primary prevention measure for CVD is promoting
smoking cessation. For every healthcare visit, nurses should assess adults for tobacco usage and
counsel them on quitting. Quitting can be enhanced by combining pharmacotherapies such as
nicotine replacement therapy (NRT) and bupropion with behavioral interventions (Stewart et al.,
2020). There should be trained staff on tobacco abstinence to help people quit. There is no safe
lower limit to secondhand smoking exposure, so adolescents and adults should avoid being
passive smokers at all costs. The nurse should conduct follow-ups to ensure success in quitting.
Nonetheless, nurses should further advise adults should reduce alcohol intake to lower CVD
Exercise and Physical Activity

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Globally, exercise and physical activity is known to have an unprecedented positive
impact on health outcomes for most illnesses, including CVDs. Nurses should educate adults to
have at least 150 min/wk of moderate-intensity physical activity or at least 75 min/wk of high-
intensity physical activity (Stewart et al., 2020). Adults who cannot meet the minimum
recommendations should engage in any physical activity and decrease any form of sedentary
behavior by taking walks.
Treating Underlying Conditions
Underlying conditions also increase cardiovascular risks, such as overweight (BMI>=25)
and obesity (BMI>=30), type 2 diabetes mellitus (T2DM), hypertension, and high blood
cholesterol. Nurses must identify these conditions and prescribe appropriate treatment options to
minimize their effect on CVD risks. Obese adults should be counseled to adopt weight loss and
regularly track their body mass index. Adults with T2DM should adopt a heart-healthy dietary
pattern. Statin therapy can be used on adults with high blood cholesterol. To control
hypertension, a nurse can recommend weight loss, heart-healthy dietary patterns, reduced sodium
intake, limited alcohol, regular exercise, and dietary potassium supplementation. Stewart et al.
(2020) also recommend using pharmacological therapies such as liquid-lowering therapy,
Polypills, Aspirin, and Anti-platelets.
There are many evidence-based primary prevention measures for CVDs. However, a
nurse should ensure to match the intensity of these preventive efforts with the absolute risks of a
future CVD event and the adult’s willingness to change their lifestyle.
Impact of Social Determinants on Health Promotion Goals
Social determinants in a given community can prevent individuals from attaining their
health promotion goals. A nurse must assess the impacts of these social determinants on a

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patient’s ability to mitigate CVD risks and devise strategies that incorporate these limitations.
African American populations are overburdened by adverse social, economic, and environmental
factors. In 2015, about 24% of African-Americans lived below the poverty line, compared to just
9% of non-Hispanic whites and 11% of Asians (Iceland, 2019). They are therefore forced to live
in impoverished neighborhoods and poor housing facilities. As a result, African Americans
disproportionately experience lower education and health literacy levels. They can barely afford
most preventive health resources such as heart-healthy diets, psychological stability from having
a permanent job with a good income, and safe space for regular exercise due to criminal and
gang activities.
Aging African Americans are also more likely to suffer from insufficient sleep, sleep
disorders, and stress generated from multiple sources, such as job strain, financial constraints,
and discrimination which further worsens their health outcomes for hypertension, obesity, and
CVDs. However, these barriers can be addressed through policies such as the Affordable Care
Act, banning smoking, providing safe parks, providing incentives for constructing food stores,
restricting selling unhealthy foods, and reinvesting in local community infrastructure.

Conclusion

The excess burden of CVDs in African American populations has become of most
significant concern, especially the considerable role it plays as a massive driver of disparities
between whites and blacks in the United States. However, aging African-American populations
can lower the cardiovascular risks and prevent future occurrence of CVD events by adopting an
effective primary prevention plan. This primary prevention plan involves a heart-healthy diet,
smoking cessation and lowering alcohol consumption, regular physical activity, effective control,
and treatment of underlying conditions alongside adopting pharmacotherapies for high-risk

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individuals. Proper implementation and achievement of this promotional plan require that nurses
adopt a patient-centered approach will enable them to identify the willingness of people to adopt
a healthy lifestyle, recognize potential challenges, and track improvements in the population.
Challenges arising from socioeconomic determinants within the African American communities
can be solved through a team-based approach with multidisciplinary health officials and state
administrators to improve local community infrastructure and CVD outcomes among the aging
African-Americans.

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