Heart disease is the top cause of death in the U.S. It’s a broad term covering different conditions that impact the heart, with coronary artery disease (CAD) being the most common.
While heart disease rates are dropping across all racial and ethnic groups in the U.S., Black adults are still 30% more likely to die from it compared to non-Hispanic white people. Among younger adults (ages 18–49), Black individuals are twice as likely to die from heart disease as their white counterparts.
High cholesterol is a major risk factor for heart disease, especially CAD. But interestingly, African Americans tend to have lower cholesterol levels than other groups. So while cholesterol matters, other factors—like higher rates of diabetes and high blood pressure—may play a bigger role.
We also can’t ignore social determinants of health. Many Black Americans face barriers to healthcare access, higher poverty rates, and lower health insurance coverage. Without early screenings and proper care, managing risk factors becomes much harder.
Cholesterol and Heart Disease
Our bodies produce cholesterol naturally—and we actually need some for cell and hormone production. But not all cholesterol is the same:
- LDL (“bad” cholesterol) can build up in blood vessels, narrowing them and raising CAD risk.
- HDL (“good” cholesterol) helps remove cholesterol from the bloodstream, protecting against heart disease.
Nearly 40% of Americans have high cholesterol, but African Americans tend to have lower LDL levels than other groups. This suggests other factors are driving their higher heart disease risk.
Cholesterol in the African American Diet
Only a small part of our cholesterol comes from food—most is genetic. If a close family member has high cholesterol, you’re more likely to as well.
Some foods may raise LDL (like red meat, processed meats, and full-fat dairy), while others (like veggies, fruits, whole grains, and nuts) may help lower it.
Food is more than just nutrition—it’s tied to culture, comfort, and connection. But dietary guidelines often unfairly label soul food or Southern cuisine as unhealthy, and nutrition studies frequently lack diversity, failing to represent real populations.
Genetics and Family History
Family history plays a role in heart disease risk. If possible, ask relatives about conditions like:
- Heart disease
- Diabetes
- High blood pressure
- High cholesterol
While genetics aren’t everything, they can offer clues about your health.
Statins (cholesterol-lowering drugs) are often prescribed to those with a family history of high cholesterol or heart disease. But African Americans are less likely to receive statins—and when they do, they often don’t get the right dosage.
Another issue? Most statin research has focused on white men, despite higher heart disease rates in marginalized groups. There’s a lack of large, high-quality studies on how statins affect People of Color.
Who’s Most at Risk for Heart Disease?
Risk factors include:
✔ Controllable: High LDL, low HDL, high blood pressure, diabetes, inactivity, stress, smoking
✔ Uncontrollable: Age, family history
Underlying Conditions
Some conditions raise heart disease risk, especially if unmanaged. While high cholesterol is a factor, other issues—like diabetes and high blood pressure—disproportionately affect African Americans:
- 19.6% of Black adults have diabetes (vs. 13% of white adults).
- 42.1% have high blood pressure (vs. 28.7% of white adults).
Steps to Lower Your Risk
- Regular Checkups – Monitor cholesterol, blood pressure, and blood sugar. Early detection helps.
- Diet – Eat more fiber (fruits, veggies, whole grains, beans, nuts).
- Lifestyle – Stay active (mix cardio, strength training, stretching) and quit smoking if possible.
Systemic Changes Needed
Individual actions help, but broader fixes are crucial:
✔ Better healthcare access
✔ Affordable healthy food (especially in “food deserts”)
✔ Safer communities to encourage physical activity
The Bottom Line
African Americans face a higher heart disease risk, but cholesterol isn’t the main reason—they often have better cholesterol levels than other groups. Instead, factors like high blood pressure, diabetes, and healthcare disparities play bigger roles.
While personal choices matter, systemic changes are essential to close the gap in heart health outcomes.