Many Black Americans experience high levels of stress. This may be due to racism, prejudice, institutional inequities, income inequality, and unfair treatment in school, healthcare, and workplace environments.

Chronic stress can deteriorate your health over time, and sometimes its damaging effects are only noticed after it’s too late. 

Cortisol is the main stress hormone in the body, governing the fight or flight response when you feel like you are in danger, as well as a plethora of bodily functions, including mediating the stress response, immune function, metabolism, and inflammatory response. Increases in cortisol are helpful over a short period of time, but high levels over a long period of time can heighten blood cholesterol, triglycerides, blood sugar, and blood pressure to increase the risk of heart disease over time.¹

This article addresses how stress affects heart disease risk in Black people.  

Race, Racism, and Stress

Stress can come from many different sources, including the effects of racism.

Prevalence 

Race is a human-derived social construct used to categorize people.

While the concept of race and the classification of people based on physical characteristics has been around for centuries, the idea that a discrete group of people can be defined by specific genetic and biological differences has been used as a tool to marginalize, oppress, and even abuse certain groups of people over others.

The Stress of Prejudice and Hate

The institution of slavery and mass genocide are two race-based events that characterize the magnitude of hate, prejudice, and moral blindness that Black and Indigenous Americans have had to endure throughout U.S. history. 

The trauma of events like slavery, coupled with institutional racism, continues to negatively impact Black people to this day.

A recent Kaiser Family Foundation poll found that over 70% of Black Americans report having experienced some form of racial discrimination or mistreatment during their lifetimes, with nearly half saying that they felt that their life was in danger at some point in their life because of their race.²

Even more, Blacks were much more likely than Latinx and White respondents to report feeling like they had been denied a job for which they were qualified (40%, 15%, and 8%, respectively) or denied housing they could afford due to their race (26%, 8%, and 3%, respectively).²

Stressors Can Be Race-Related 

Racism is a special kind of stress that impacts many Black, Indigenous, and other people of color, but especially Black Americans.

Exactly how the stress of racism deteriorates health remains a mystery, but some research finds that repeated exposure to discrimination and systemic inequity is associated with the biological aging of the cells.³

The genetic changes that lead to aging and lower functioning cells is a phenomenon called biological weathering, and its impact comes as a result of repeated exposure to:

• Socioeconomic adversity
• Political marginalization
• Racism
• Perpetual discrimination

Another study found that anticipating prejudice can lead to cardiovascular stress responses, which can also increase the risk of heart disease in Black people.⁴

Why Stress Is a Risk Factor for Heart Disease 

The effect of stress is frequently underestimated.

Stress can be caused by financial troubles, divorce, loss of a loved one, or chronic illness.

Chronic stress increases cortisol, which raises your blood pressure and lowers your HDL (good cholesterol).⁵

Chronic stress is also associated with many health-compromising behaviors that may affect your heart in a more indirect way. When you’re worried, you tend to:⁶

• Sleep poorly
• Exercise less
• Make poor food choices
• May not watch your weight

These lifestyle changes put your heart health at increased risk.

Underlying Cause of Chronic Stress Disparities

Some of the most common chronic stressors associated with health disparities include:

• Perceived discrimination
• Neighborhood stress
• Daily stress
• Family stress
• Acculturative stress (stress that occurs when one culture comes into contact with another culture)
• Environmental stress
• Maternal stress

Current research shows that these stressors are more commonly experienced by Black people and lead to chronic stress in addition to long-term feelings of hurt and hopelessness.⁴

Social determinants of health—such as education, access to quality care, neighborhood safety, and proximity to pollution, to name a few—... impact health and well-being and play a role in race-based differences in health.⁷

Discussing Stress With Your Healthcare Provider

It is more important than ever to know how to discuss stress with those who may have the power to help you change it—namely, your provider.

Finding a provider that you trust and respect opens the door for an honest and open discussion about the best ways for you to cope with your stress and implement heart-healthy lifestyle changes. 

Finding a Trustworthy Provider 

Seeking out empathic, equitable, and unbiased medical care as a Black person in the United States takes time, attention, and intention.

Many Black people report that they are more likely to feel comfortable with Black healthcare providers and more likely to adhere to certain preventive measures delivered by Black healthcare providers.

While Black healthcare providers are more likely to practice in underserved communities—often concentrated in urban areas—more rural areas may have few if any.

As of 2024, 5.4% of physicians identified as Black despite Black Americans making up 13.4% of the U.S. population.⁸

Finding a Black Healthcare Provider

There are websites that help you connect with Black healthcare providers. These include:

• Blackdoctor.org
• Findablackdoctor.com

For many Black people, finding a trustworthy provider is often centered around finding a Black provider, period. That alone raises the chances you might get the quality of care you need.

A history of biased and substandard care from White providers is one reason why Black people are more trusting of Black providers.⁹

What Is Implicit Bias?

Implicit bias—a type of prejudice in which racial stereotypes are formed without conscious intention—is often experienced by Black people, unbeknownst to the non-Black provider, compromising care.¹⁰

Black providers are also more likely to provide culturally specific care.

Questions to Ask

Choosing the right healthcare provider isn’t easy. It requires you to ask many important self-reflective and open-ended questions to yourself and the office staff to ensure that they are right for you. 

Some introspective questions you might ask yourself include:

• How far am I willing to travel to see my provider?
• How important is it that my provider looks like me? Will a healthcare provider who does not look like me but provides culturally competent care suffice?
• How does this healthcare provider fit into my schedule? Do they have after-hours services?
• What kind of healthcare provider am I looking for?
• I really like this healthcare provider, but they do not take my insurance. Am I willing to pay out of pocket?

Some questions you may want to ask your healthcare provider directly include:

• Have you worked with Black people before? 
• What does culturally competent care mean to you? How do you ensure that your care is culturally competent?
• Do you provide genetic testing?
• How long is a typical appointment?

You may also want to ask the staff and other people who have previously worked with your potential provider about their experience. While you cannot, and should not, base your decision solely on the opinion of others, sharing what you know can add perspective to this very important decision. 

An Integrative Treatment Approach

Identifying the underlying cause of your stress and addressing it is the single most important measure you can take to mitigate your heart disease risk.

The following are the components of an integrative approach that address the many factors that contribute to your stress.

Medication

Any illness—whether mental or physical—can cause stress and maladaptive changes in the body.

Some of these conditions—like heart disease, diabetes, depression, or anxiety—can be made better with the help of medication.

Medication use is sometimes taboo in the Black community, but research shows that using medication as prescribed by your healthcare provider can help manage your underlying health conditions and is a great way to alleviate stress and promote healing.¹¹

Therapy 

Black people are just as likely as any other group to experience mental illness. Oftentimes, mental illness stems from stress and the constant need to fight against oppressive systems. Mistrust in the healthcare system, mental health stigma, and lack of access to care are only a few of the reasons why only half of Black adults with mental illness get treatment.¹²

A professional therapist can help you understand what feelings are typical for your circumstances and offer strategies to support your immediate and long-term needs.

Therapy sessions also give you a safe space to get things off your chest and the added benefit of not only helping you to understand yourself better but also understanding other people. You may not feel the positive impacts of therapy immediately, but over time many people come to consider therapy as a powerful tool and a gift that you give yourself.

Lifestyle 

Healthy habits protect you against stress you haven't even experienced yet. Making lifestyle changes aimed at curbing overwhelming levels of stress is a part of any comprehensive stress relief plan.

Finding healthy ways to calm down not only helps you to avoid the negative effects of chronic stress, especially indolent conditions like type 2 diabetes and high blood pressure that silently damage the heart, but also brings added health benefits like the release of endorphins that heighten brain and body function.

The following healthy habits may greatly prevent or reduce your stress, protecting your heart in the process:¹³

• Regular exercise
• Eating a heart-healthy diet
• Never smoking and limiting alcohol
• Getting quality sleep
• Enjoying activities and talking with supportive groups of friends and family

Stress Management 

Taking breaks at work, talking to supportive friends, eating healthy, and going for a run after work or school are some ways that you can manage your stress.

The goal isn’t to avoid stress at all costs—that’s nearly impossible to do—but to find ways to address stressful situations in a healthy way and limit the amount of negative stress that you experience in your life.

Resources

There are many resources you can tap into to help you manage stress in your life. Some options are listed below.

Support Groups

Whether you’re seeking support for coping with an illness, a new diagnosis of heart disease, caregiving, depression, or simply trying to overcome the uneasiness of your current situation, attending a support group can be a valuable step toward healing.

The Association of Black Cardiologists specializes in the prevention and treatment of cardiovascular disease in Black people and has created Mended Hearts, a support group that sets out to inspire hope and improve the quality of life of people with heart disease and their families. 

Finding a local support group may be the first step in your journey towards recovery. Many other local support groups exist, providing immense value to many Black people who are in the midst of the healing process. Attending these sessions with openness and a positive spirit are integral to getting the most out of this experience, but it’s important to note that everyone’s healing process is different, so take your time and move at your own pace. 

Family and Peers

Family and friends are great sources of social support. These are the people who know you the best and can understand what you’re going through.

Sometimes you may feel like you have the weight of the world on your shoulders but stress is made worse when you bottle it up inside. Talking things out with people you trust is a good way of getting things off your chest and freeing your mind of negative thoughts that can eat away at your health. 

Summary

Black people are disproportionately impacted by stress and stress-related disease due to systemic inequality. High levels of cumulative stress put many Black people at high risk of heart disease which can lead to heart attack and stroke. 

A Word From Verywell 

Chronic stress can stem from poverty, a dysfunctional marriage or family, or a deeply dissatisfying job, but the causes are truly endless. Limiting stress and living a healthy lifestyle are surefire ways to lower your heart disease risk. The importance of taking every measure possible to curb stress cannot be understated, especially in Black communities that have been historically marginalized. 

Frequently Asked Questions

What’s the link between race and stress in America?

High levels of stress over a long period of time ages your cells causing them to malfunction. As a result, many Black Americans are at high risk of developing diseases of adaptation, namely high blood pressure, high blood sugar, type 2 diabetes, and weight gain.³

When does stress become chronic?

There is no timeframe that designates stress as acute or chronic, but generally speaking, stress is considered chronic when it occurs for months or years and the frequency or intensity is such that the autonomic nervous system does not have an adequate chance to activate the relaxation response on a regular basis.

How can Black people find better mental health services?

There is a growing number of Black specific mental health services and providers. Information on where to find these places can be found on social media, the local paper, and on websites like:

• Blacktherapistsrock.com
• Blackmentalhealth.com
• BorislHensonfoundation.org
• SurvivorsHaveHeart.com

What does stress do to the heart?

Chronic stress can lead to maladaptive changes that decrease the heart cells’ ability to function normally. Constantly dealing with stress also increases the likelihood of engaging in poor health behaviors linked to increased risk for heart disease and stroke, such as:¹⁴

• Smoking
• Overeating
• Lack of physical activity
• Poor sleep hygiene
• Unhealthy diet, and 
• Not taking your medications as prescribed

SOURCES

1. Oakley RH, Cidlowski JA. The biology of the glucocorticoid receptor: new signaling mechanisms in health and disease. J Allergy Clin Immunol. 2013 Nov;132(5):1033-44. doi:10.1016/j.jaci.2013.09.007
2. Kaiser Family Foundation. Poll: 7 in 10 Black Americans say they have experienced incidents of discrimination or police mistreatment in their lifetime, including nearly half who felt their lives were in danger.
3. Chae DH, Wang Y, Martz CD, et al. Racial discrimination and telomere shortening among African Americans: the coronary artery risk development in young adults (Cardia) study.Health Psychology. 2020;39(3):209-219. doi:10.1037/hea0000832
4. Sawyer PJ, Major B, Casad BJ, Townsend SSM, Mendes WB. Discrimination and the stress response: psychological and physiological consequences of anticipating prejudice in interethnic interactions. Am J Public Health. 2012;102(5):1020-1026. doi:10.2105/AJPH.2011.300620
5. Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2012;9(6):360-370. doi:10.1038/nrcardio.2012.45
6. Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: a review. EXCLI Journal; 16:Doc1057; ISSN 1611-2156. Published online 2017. doi:10.17179/excli2017-480
7. Islam MM. Social determinants of health and related inequalities: confusion and implications. Front Public Health. 2019;0. doi:10.3389/fpubh.2019.00011
8. Association of American Medical Colleges. Diversity in medicine: facts and figures 2019.
9. ClinicalTrials.Gov. The Oakland men's health disparities study.
10. Alsan, Marcella, Owen Garrick, and Grant Graziani. 2019. Does diversity matter for health? Experimental evidence from Oakland. American Economic Review, 109 (12): 4071-4111. doi:10.1257/aer.20181446
11. Alvarez C, Hines AL, Carson KA, et al. Association of perceived stress and discrimination on medication adherence among diverse patients with uncontrolled hypertension. Ethn Dis. 2021;31(1):97-108. doi:10.18865/ed.31.1.97
12. Mental Health America. Black and African American communities and mental health.
13. Can YS, Iles-Smith H, Chalabianloo N, et al. How to relax in stressful situations: a smart stress reduction system. Healthcare. 2020;8(2):100. doi:10.3390/healthcare8020100
14. American Heart Association. Stress and heart health.

Black Americans have a 30% greater chance of dying from heart disease than White Americans.¹ But, according to statistics from the American Heart Association, fewer Black Americans are affected by high cholesterol than White Americans.²

Despite the lower total cholesterol levels, researchers report that African Americans are still at greater risk of dying of heart disease. According to the Office of Minority Health at the U.S. Department of Health and Human Services, African Americans are actually less likely to be diagnosed with heart disease than Whites.³ This may point to one of the reasons behind the disparity.

Cholesterol Levels in Black Americans

According to the American Heart Association, Black men and women tend to have slightly lower total cholesterol levels than Whites. The Association reports that 44.8% of Black men and 42.1% of Black women have high or borderline high total cholesterol levels. By comparison, 47.9% and 49.7% of White men and women have high or borderline high levels.

Black men did have slightly higher reported levels of LDL, low-density lipoprotein, the "bad cholesterol," levels. The association reports that 32.4% of Black men and 31.7% of white men have borderline high or high LDL levels. Both Black men and women had somewhat higher HDL, or high-density lipoprotein, known as "good cholesterol."

Racial Disparity Theories

Scientists aren't completely sure why some ethnic groups are at higher risk for cardiovascular disease, but there are ways in which genetics and other factors may play a role.

Genetics

Your genetics influence how your food is metabolized and how much cholesterol your body produces. Cholesterol isn't just found in food; your liver actually creates about 75%  of your blood cholesterol. Your genetic makeup can influence how much cholesterol is created and what your ratio of LDL to HDL is.

Researchers are narrowing in on genes that may be the cause of high cholesterol, high blood pressure, and other cardiovascular disease factors, but they aren't there yet.

Obesity

Obesity is one predictor of cardiovascular disease that is more prevalent among African Americans. According to data collected in 2017 and 2018, rates of obesity were highest among African Americans (49.6%). However, rates for White Americans were not much lower (42.2%).⁴

A CDC report found that 48.7% of African Americans had two or more risk factors for heart disease, compared to 35.5% of Caucasian Americans. The risk factors studied included diabetes diagnosis, smoking habits, sedentary lifestyles, obesity, hypertension, and high cholesterol.

Disparities in Care

Statistics from the Office of Minority Health indicate a healthcare disparity within U.S. hospitals. Research indicates that African Americans are less likely to receive a non-aspirin antiplatelet drug when hospitalized in regions including Maryland, North Carolina, Mississippi, and Minnesota.⁵ These statistics may represent a larger problem.

Disparities in the way Black Americans and White Americans are treated in medical settings are well-documented. These disparities may help explain the differences in heart disease outcomes for each race.

Lowering Cholesterol and Heart Disease Risk

It's important to take personal responsibility for your cardiovascular risk factors. The National Institutes of Health offers the following tips for lowering cholesterol and cardiovascular risk:⁶

• Quit smoking.
• Reach and maintain a healthy weight.
• Focus on eating at least five servings of fruits and vegetables daily.
• Choose poultry, fish, and plant-based foods instead of red meat.
• Make 30 minutes of exercise a daily routine.

It's also important to communicate with your physician. Most healthy adults over 21 should have their cholesterol checked every four to six years. Those with heart disease or diabetes or who have a family history of high cholesterol should have it checked more often.⁷

If your cholesterol is high, your physician can advise lifestyle changes and possibly medication to help lower cholesterol levels and overall cardiovascular risk.

Summary

African Americans are at greater risk of dying of heart disease, despite lower rates of cholesterol and rates of obesity that are not significantly higher than rates of obesity among White Americans. Researchers are unsure why the disparity exists, although there are well-established differences in the quality of care received in medical settings for Black Americans and White Americans.

You can take charge of your health by lowering your risk of health diseases with lifestyle changes. Try to increase your intake of heart-healthy fruits and vegetables and incorporate physical activity into your routine. Also, work with your healthcare provider to evaluate and manage other risk factors.

SOURCES

1. University of Chicago Medicine. Heart disease and racial disparities: Why heart disease is more common in Black patients and how to prevent it
2. American Heart Association. Ethnicity a 'risk-enhancing' factor under new cholesterol guidelines
3. U.S. Department of Health and Human Services Office of Minority Health. Heart Disease and Black/African Americans
4. Lofton H, Ard JD, Hunt RR, Knight MG. Obesity among African American people in the United States: A review. Obesity (Silver Spring). 2023 Feb;31(2):306-315. doi:10.1002/oby.23640
5. American Heart Association. Differences remain in heart attack treatments for black patients
6. National Heart Lung and Blood Institute. Therapeutic Lifestyle Changes (TLC) To Lower Cholesterol
7. Centers for Disease Control and Prevention. Testing for cholesterol.