NIH Record - National Institutes of Health

African Americans Who Smoke May Be at Higher Risk for Heart Disease

Black male doctor holds cigarette in one hand and wags finger with other hand to warn black male patient not to smoke.
African Americans who smoke are more vulnerable to heart disease.

Photo:  Credit DME Photography/Getty

African Americans who smoke appear to have more than twice the risk of developing coronary heart disease compared to non-smokers. The new study—the first up-close look at the relationship between smoking and coronary heart disease in this population—also examined the risk for plaque buildup in the arteries, a predictor of heart attacks and heart failure.

The findings, published in the Journal of the American Heart Association, draw on data from nearly 4,500 participants in the Jackson Heart Study, the largest cohort study investigating cardiovascular disease exclusively in African Americans. That study, as well as the new research, is supported by NHLBI and NIMHD. 

Coronary heart disease affects more than 20 million adults in the U.S. and causes 1 in 7 deaths, according to the CDC. Compared to whites, African Americans are more likely to die from coronary heart disease. 

Despite a marked decline in smoking among African-American adults in recent years, almost 15 percent reported current cigarette smoking in 2019. Yet the link between cigarette smoking and coronary heart disease has been understudied in this population.    

African Americans have disproportionally higher rates of hypertension, diabetes and obesity—known risk factors that partly explain the greater death toll from coronary heart disease in this community,

“But smoking is also a well-documented risk factor, which, combined with the others, suggest that African-American smokers represent a particularly vulnerable population for this disease,” said lead study author Dr. Adebamike Oshunbade, a postdoctoral fellow at the University of Mississippi Medical Center. 

The investigators used coronary artery calcification (CAC) scores, measured by CT scans, to assess the degree of calcified plaque buildup in participants’ coronary arteries. The study followed 4,432 participants without a history of coronary heart disease at the time (2000-2004) through 2016. The researchers found that current smokers had an increased likelihood of a higher CAC score and double the risk of coronary heart disease.

“Smoking is a modifiable risk factor for cardiovascular disease,” said Dr. David Goff, director of NHLBI’s Division of Cardiovascular Sciences. “Fully addressing tobacco-related disparities requires addressing conditions where people live, work and play.” 

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