“Lower is better,” said Dr. David Montgomery, a cardiologist with PREvent Clinic here in Atlanta, referring to high bad cholesterol (LDL) which he describes as the leading cause of heart disease and heart-related deaths among African Americans. “When it comes to bad cholesterol we know that lower is better. When we get people’s cholesterol to go lower, they get better. High bad cholesterol leads to cardiovascular disease.”
Montgomery, who had the responsibility of hosting the forum along with Dr. Jayne Morgan—a cardiologist with Piedmont Healthcare, shared these words during a recent forum held by the Association of Black Cardiologists (ABC) with Black community leaders in downtown Atlanta, on Friday, Nov. 22, at the Commerce Club.
They were joined by a panel of medical professionals and community leaders which consisted of Kevin Loften, CEO of CommonSpirit Health; Rep. Doreen Carter (D-Lithonia) District 92; Dr. William Watkins CMO of Piedmont Henry Hospital; Joanne Hill, executive director of diversity and inclusion for Piedmont Healthcare; Janis Ware, publisher of The Atlanta Voice Newspaper; and the Rev. Dr. Darrell Elligan, a pastor at True Light Baptist Church in Atlanta.
The discussion was centered around the disparities in health care for African Americans and the lack of access; particularly when it comes to heart-related issues.
“People of color die more from heart disease than anybody else,” Montgomery said. “Although the mortality rates are going down, 284 fewer deaths in blacks, 120 in whites, the gap is so large that we’re starting at such a deficit that that doesn’t even scratch the surface.”
“With all of the disparities, it reduces the life expectancy of African Americans by 3.5 years. About 40 percent of the gap and disparities come from heart disease.”
Montgomery continues to say that African Americans in Atlanta are living in one of the regions which a very high percentage of patients diagnosed with heart-related diseases, referring to the southeastern United States as “the hotbed for disease.”
“We know that there are more diabetes and hypotension in Blacks in (the southeast), and therefore there’s more cardiovascular disease,” Montgomery said. “There are multiple social determinants of health, and money have to do with where you live.”
However, Montgomery and most physicians would argue that one of the biggest determining factors for heart-related issues is high cholesterol.
“We use a fancy word, dyslipidemia, for non-clinicians. Dyslipidemia in men is one of the leading risk factors for young folks, folks that are under 60-years-old to have their first heart attack,” Montgomery said.
“We know that one of the main ways to get people’s cholesterol to come down unless you have a genetic abnormality is exercise and diet.”
As for women, it seems as though women of color are at a greater risk than men, Montgomery said.
According to the American Heart Association, nearly half of Black women have some for have cardiovascular disease, an umbrella term for heart-related disorders. Approximately 41 percent of black women have high blood pressure, 82 percent are overweight or obese, and 14 percent have diabetes.
Carter advocated that because there hasn’t been enough research on women in relation to heart disease, most women are uninformed in how to detect heart-related issues that may present themselves differently in their male counterparts.
“What we’ve attempted to do every year since I’ve been in the legislature is to make aware, to women especially, that heart disease is the number one killer,” Carter said. “One of the reasons why is that our symptoms of a heart attack is different than the information we’ve been provided because most of the studies have been done on men.
“And I would argue to say that we have less women, maybe because we died.”
However, with all of this information surrounding the dangers of heart diseases, especially among African Americans, the question still remains, why are we still dying from it.”
Surprisingly, this group of medical professionals and community leaders have identified the answer, which is access. Access to information, access to healthcare, and access to clinical trials.
“A lot of the access issue comes from physicians not doing what we’re supposed to do patients get approved,” Morgan said.
She and her fellow colleagues agree that access to clinical trials is one of the primary ways African Americans can ensure that they receive the best medical care. And she would say that if a patient is not being offered a clinical trial, they might be receiving optimal care but not maximal care.
“Clinical trials, especially in cardiology and oncology, that can potentially add precious years to your life go unaccessed by members of our community.”
According to the National Institute of Health and National Institute on Minority Health and Health Disparities, minorities, in general, account for less than 10 percent of enrolled patients in clinical trials across the United States.
Morgan pointed to the lack of trust, the engagement between academic researchers and the community, economic means, practicality (travel and frequent appointments), and participation from Black doctors, are the main reasons why African Americans remain unable to gain access to some of the clinical trials that would be beneficial to our health.
‘We are not principal investigators,” Morgan said. “We are not connected nor have a connection to the academic institution, nor the drug and device companies.
“We got to get ourselves ready. We must overcome these barriers or we will be left behind. We are being left behind. We have been left behind. It’s time.”
Morgan continued, “The most important reason that we need participation is to ensure that the discoveries, the treatments, the interventions, the strategy algorithms that are developed are going to be relevant to our population.”
She also let the forum’s attendees in on a “dirty little secret” regarding the economic benefits for patients who take part in clinical trials.
“If you’re enrolled in a research trial, most of your medical care is free,” Morgan said. “So, if you can’t afford medical care, a clinical trial is a way to get into the backdoor and get it done. The hospital will cover it, your drug companies will cover it, and device companies will cover it.”
Recognizing that a common concern among African Americans is the notion that they’re being used as modern-day guinea pigs Morgan says that the process is standard towards all patients, heavily regulated by the U.S. Food and Drug Administration (FDA).
“In drug and device development, a compound or device may be under study for nearly a decade before the FDA approves any drug or device such that the general public can access it,” Morgan said. “All trials, especially those that are here from sponsors, meaning drug companies and device companies, have FDA approval before we can open them. It comes through the FDA, the FDA monitors it, and mandates it.”
“What happens in a clinical trial is that data is being gathered on you along with hundreds of other patients. That data has to be validated, it has to be standardized, people’s jobs are on the line. It is their job to get it right because these drugs have to go before the federal drug administration.
According to Morgan, medicine and health care is currently undergoing a rapid evolution, and in a decade, the healthcare system that we have in a decade might be drastically different from the one that exists today.
Unfortunately, African Americans can’t afford to be left behind while medical advances are being made to improve health, save lives, and extend life expectancy. So, it’s not only important that the African American community gains access to this type of information and care, but also it is equally important that African American medical professionals and leaders participate in the administrative level.
“In our lack of engagement, very few minorities like myself are in senior positions of decision and leadership within research facilities,” Morgan said. “That shapes the dynamic of who is offered to these trials. Having a seat at the table in leadership.”