The following are key points to remember from this review on eliminating disparities in cardiovascular disease (CVD) for Black women:

1. Black women have higher cardiovascular (CV) morbidity and mortality rates than women of other races/ethnicities. Younger Black women are 2-3 times more likely to suffer premature CV death; furthermore, Black women residing in rural areas have the highest CV mortality rates in the United States.
2. The lifetime risk for hypertension is estimated to be 85.7% for Black women; despite higher rates of awareness, Non-Hispanic Black (NHB) women have lower rates of blood pressure control than Non-Hispanic White (NHW) women. In addition, NHB women have a twice higher rate of diabetes-related death than NHW women. Rates of statin use for eligible Black women are also low.
3. For Black women, rates of adverse pregnancy outcomes are higher than for other groups. Compared with NHW women, NHB women are significantly more likely to experience preterm birth, hypertensive disorders of pregnancy, and small-for-gestational-age birth. Furthermore, Black women have a 2.9 times higher pregnancy-related mortality ratio than White women. Among women with pregnancy-induced hypertension, Black women had a higher stroke risk than NHW women.
4. Social factors, including social determinants of health, are associated with CV outcomes. Social isolation is associated with increased CVD mortality in Black women compared to White women. Black women with lower social and economic status have almost three-fold odds of having worse CV health than White women in both rural and urban areas.
5. Although there is a greater appreciation of race as a social, cultural, and geopolitical construct instead of a biological variable, these subgroups are often studied as a homogenous group. The use of racial categories dates to the 18th and 19th centuries when skin color and physical traits attributed to different continents were used to identify White people and populations of African origin. Based on data collection instruments and migration trends, Black women comprise those who are United States born (African American), African born (African), and Caribbean born (Afro-Caribbean).
6. Steps toward reducing barriers to equitable care for Black women include increasing workforce diversity. Only 2.6% and 2.8% of active US physicians are Black men and Black women, respectively. In addition, rates of Black scientists, including physician-scientists, are low and less likely to receive funding compared to White counterparts. Black women are overrepresented in health care professions at 13.7%, but are employed mostly in the lowest-wage and most hazardous jobs.
7. Furthermore, increased representation in clinical trials and community partnership in clinical care and research will assist in reducing disparities for Black women. Professional societies can promote and train providers and administrators in accountable health care, standardize race/ethnicity terminology, and develop health equity guidelines and curriculum to promote health equity in medical education and training.
8. Implementation of training to mitigate bias and discrimination is recommended. Educating clinicians on implicit bias mitigation may result in increased personal awareness, process change, and enhanced patient trust. In addition, translating these lessons to decision-making related to learner selection, hiring, and promotion by health care organizations could have the effect of an increase in healthcare workforce diversity and, ultimately, the delivery of more equitable health care.
9. Additional actionable items include recognition of the role of chronic stressors on CV risk. Clinicians should recognize and address these by using validated depression and anxiety screening measures and referring to behavioral health management when needed. Additionally, clinicians should engage in collaborative patient-centered communication and multidisciplinary team-based care that can positively affect the psychological health of Black women. Further, integrating assessment of social determinants of health into clinical practice can assist in holistic patient care to reduce CV risk factors and events.
10. Government agencies are recommended to consider the health impact of all policies. In addition, reimbursement policies should be revised to prioritize health equity and equitable health care. Last, governmental agencies can play a role in enhancing research through training and capacity building for a diverse scientific workforce and study populations representative of all groups.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Vascular Medicine, Nonstatins, Novel Agents, Statins, Hypertension

Keywords: African Americans, Blood Pressure, Cardiovascular Diseases, Diabetes Mellitus, Economic Status, Education, Medical, Ethnic Groups, Health Equity, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertension, Pregnancy-Induced, Morbidity, Patient Care Team, Patient-Centered Care, Pregnancy, Pregnancy Outcome, Primary Prevention, Social Determinants of Health, Social Factors, Stroke, Women, Workforce

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