It’s Not You, It’s Your Genes: The Hidden Cause Of Heart Disease In Black Women

Imagine evolving in your health and wellness journey by focusing on a heart-healthy lifestyle through dietary adjustments, increased exercise, and the moderation of your beloved glasses of wine. Yet, despite following the suggested guidelines for optimal cardiovascular health, you discover that you still face the threat of heart disease and that the underlying cause lies within your DNA.

For Black women, in particular, the genetic makeup or what runs in one’s family, has a significant impact on our heart health. Amidst the plethora of discussions on maintaining a healthy heart, one crucial aspect has often been excluded from conversations: Lipoprotein (a), commonly known as Lp(a).

Lp(a) is a specialized type of lipoprotein that carries cholesterol in the blood and is quite different from other more common forms.

“This particular type is genetic and increases the risk of heart disease, independent of your diet and exercise,” says Keith C. Ferdinand, MD, a cardiologist specialist and professor of medicine at Tulane University School of Medicine. “And because it is genetically determined, it can cause a risk for premature or sudden heart disease or strokes.”

The intricacies of Lp(a) add to the already complex conversation of heart disease risks for Black women, who are 60 percent more likely than white women to have hypertension—one of the leading causes of heart disease, according to the American Heart Association.

Research suggests that Black and South Asian women tend to have higher average levels of Lp(a) compared to other ethnic groups, and while Ferdinand says there are no concrete studies that offer insight as to why these groups are affected the most, he offers a theoretical perspective.

“There are certain genetic tendencies, which before modern times may have been protective but are now considered a disease,” he says. “Perhaps Lipoprotein (a) had some protective factors that we can’t identify.  Because it increases blood clotting, with humans developed in Sub-Saharan Africa, perhaps it was beneficial to have a substance that would help the blood clot quicker due to trauma, falls or child birth.”

Nonetheless, he reminds us that this is just a theory, as the research on Lp(a) is limited, so much so that the awareness amongst doctors and clinicians is relatively recent.

“Traditionally, Lp(a) is not measured when checking for cholesterol,” says Ferdinand. “But now that doctors are learning that it is a powerful factor in heart diseases, clinicians are increasingly acknowledging the need to incorporate Lp(a) testing into standard cardiovascular risk assessments.”

Because Lp(a) testing isn’t yet common, he stresses the importance of Black women advocating for themselves by requesting a test during regular checkups—especially if there is a family history of premature diseases.

“Shared decision making and conversation between the patient and clinician can help identify risks and determine if you should get tested for Lp(a),” he says. “So, it’s important for you and your doctor to know and understand your family history of heart disease.”

While it can be disheartening to know that despite doing the “right things,” you can still be prone to heart disease, all is not lost. There are some proactive measures that can be taken to enhance overall heart health, indirectly influencing the risks associated with Lp(a).   

Ferdinand advises people who may believe that they have a predisposition to elevated Lp(a) levels to still refer to still maintain a healthy weight, avoid smoking, choose healthy foods and drinks, and get regular physical activity.

So, this February, during American Heart Health Month, get more proactive with your cardiovascular health in a different way. Learn more about your family’s medical history and talk to your doctor about Lp(a) testing. These measures have the potential to make a significant impact on your heart health journey and could even prove to be lifesaving.