Vascular health: The hidden weight on Black hearts

As a GP and lifestyle medicine physician, I spend a great deal of my time talking to people about their hearts, their blood vessels and their blood sugar. And the same pattern keeps showing up: heart disease, diabetes and stroke weigh more heavily on Black people than on almost anyone else. In this piece I want to explain why, what it means for your body, and, most importantly, what we can do about it.

Why the risk is higher

Race and ethnicity play a real role in heart disease and stroke, but not because there is something wrong with being Black. Black adults carry a higher burden of high blood pressure, diabetes and stroke than their white counterparts, largely because of social factors: limited access to resources, to quality education, to good healthcare and to safe living environments. These are not simply choices individuals make. They are conditions many people live in.

There is also something much closer to home, and that is the amount of salt in our cooking. Much of it comes from the food enhancers we rely on for flavour, the stock cubes and seasoning mixes that sit in almost every African and Caribbean kitchen. All of these factors feed into the high blood pressure disparities we see among Black people.

High blood pressure: the thread that runs through it all

In the United States, around 58 to 60% of Black adults have high blood pressure, one of the highest rates in the world. In the UK, people of Black African and Black Caribbean heritage are also at higher risk than white people, and in South London stroke is around twice as common in Black people and strikes years younger. That matters because high blood pressure does not stay in one place. It raises the risk of heart disease, stroke, organ damage, heart failure, kidney failure and stroke-related death. In other words, every organ in your body can be affected.

It is also important to understand that a stroke is not a single event. Once you have had one, many other things can follow, and your risk of dying increases. These trends persist in the UK and across the global Black diaspora. Wherever you find Black people in the world, you find the same pattern.

What makes high blood pressure so dangerous is that most people who have it feel perfectly well. You cannot rely on symptoms to tell you something is wrong. The only way to know is to have your blood pressure checked, and to keep checking it.

Diabetes affects every organ

Diabetes harms the blood vessels in the kidneys, the brain and the heart. I describe it as a multi-system, multi-organ, multi-vascular disease, because it affects every organ and every vessel in the body. It is never "just diabetes". Left unchecked, it can affect your eyes, your feet, your kidneys and your heart.

Diabetes damages blood vessels and often comes with unhealthy cholesterol levels, and people with diabetes are about twice as likely to have a stroke. Unhealthy lifestyle choices contribute to a large share of early deaths. But we also know for a fact that positive changes, such as exercise, a healthy diet and quitting smoking, significantly reduce the risk of heart disease. The same lifestyle that raises the risk can lower it.

The ABCDE of prevention

A simple way to remember the lifestyle changes that protect your heart and brain is ABCDE.

A is for alcohol. There is no easier way to say this: if you drink alcohol, plan to stop, because alcohol causes a lot of problems. At the very least, stay within 14 units a week, spread over three or more days, with several drink-free days.

B is for blood pressure. The goal is to bring it down. With the right changes, some people have gone from taking two or three blood pressure medications to taking none at all. But please never stop your medication on your own. Many people will need it long term, and any change should be made with your doctor.

C is for cholesterol. High "bad" cholesterol increases your risk of heart disease and stroke, so work with your doctor to bring your levels down.

D is for diabetes and diet. Type 2 diabetes is one of the chronic illnesses that healthy lifestyle changes can improve and, for some people, put into remission. Diet is at the centre of that. We need to eat more whole foods, more plants, more fruit and more vegetables, drink more water, and cut down on processed foods.

E is for exercise. Exercise is essential. Focus on what you can do, and do it consistently. Consistency will always beat intensity.

Small swaps in the kitchen

Changing how we cook does not mean giving up the food we love. There are good, healthy choices you can bring into your home and use every day that will make a massive difference:

• Lower-sodium salt alternatives in place of regular table salt
• Low-salt or zero-salt stock cubes in place of standard ones
• Seasoning with herbs, spices, garlic, onion and pepper so you need less salt for flavour
• Checking labels on seasoning mixes, which can be high in salt and flavour enhancers

These swaps are simple, but because salt drives so much of the high blood pressure in our community, they are among the most powerful changes you can make.

How systemic racism shapes heart health

I would only be telling you half the story if I stopped at lifestyle. Systemic racism affects cardiovascular health among Black people in several concrete ways.

Access to healthcare. Where you live determines the kind of healthcare you can reach.

Socioeconomic disparities. How much you earn and your level of education affect how much access to healthcare you have.

Access to nutritious food. Organic produce and grass-fed meat are expensive. It is so easy to go down to the chip shop or a cheap takeaway and buy something processed, but good food costs more. The more you earn, the more access you have.

Lack of representation in clinical trials. Far more clinical trials are carried out in white people than in Black people, which means the evidence our treatments are based on often does not reflect us.

Generational health. Yes, disease runs in families. But habits run in families too, and that is something we can change for the next generation.

What needs to change

To tackle these disparities we need several things at once.

• Policy change: policies need to change in favour of Black communities.
• Improved healthcare: better services in the communities where Black people live.
• Community engagement: people coming out, engaging with society and speaking up.
• Education: the more you know, the more you can question things and seek what you need to better yourself.
• A real fight against systemic racism.

What you can do today

You do not have to wait for the system to change before you protect yourself. Know your numbers: get your blood pressure, cholesterol and blood sugar checked, especially if heart disease, diabetes or stroke runs in your family. Look at the salt in your kitchen. Find a form of movement you can keep doing. If you drink, start planning to stop. And if you are already on treatment, keep taking it and keep talking to your doctor about how it is going.

Above all, speak up. Ask questions about your results, your medication and your options. Education is how we start to reverse the damage systemic racism has done to Black hearts, one household at a time.