Black women face a higher risk of heart failure and worse outcomes after diagnosis compared with White women. A new study suggests stress from racism and childhood sexual abuse contributes more than previously recognized.
Discrimination in daily life linked to higher heart failure risk
The study, published in JAMA Network Open, analyzed data from nearly 48,320 Black women across the U.S. tracked for a median of 24 years. During that period, 1,343 developed heart failure.
Participants reported experiences of interpersonal racism in three areas: daily interactions, employment, and housing or police encounters. Over half faced workplace discrimination, 36% encountered it in housing, and 23% during police interactions. Eleven percent experienced discrimination in all three settings.
After adjusting for demographic and clinical factors, women who reported discrimination in all three areas had a 27% higher risk of heart failure than those who reported none. The risk rose with each additional domain of exposure.
Daily racism, measured by a stress score, initially showed a connection to heart failure. That link faded after accounting for body mass index and other clinical factors. BMI seemed to explain much of the relationship.
Childhood trauma leaves lasting cardiovascular effects
The research also examined the impact of childhood and adolescent sexual abuse. Among the 31,420 participants who answered questions about abuse in 2005, those who experienced frequent sexual assault during adolescence—defined as four or more times—had a 44% higher risk of heart failure after adjustments. The connection was weaker for childhood abuse and did not reach statistical significance.
BMI accounted for 20% to 36% of the link between sexual abuse and heart failure. Stress-related eating behaviors and biological responses, such as activation of the hypothalamic-pituitary-adrenal axis, might contribute to long-term cardiovascular harm. The study did not directly measure these mechanisms, however.
Earlier research from the same group found discrimination in employment, housing, and police interactions tied to a higher risk of coronary heart disease among Black women. Everyday racism showed no significant link after full adjustment.
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The study has limitations. Heart failure diagnoses were self-reported, though medical records confirmed 78% agreement with clinical criteria in a subset of cases. The observational design means the results show associations, not causation, and unmeasured factors could influence the findings. Reports of discrimination and abuse relied on participants’ memories, which may be affected by recall bias.
The long follow-up period offers a rare look at how early-life stressors shape health outcomes later in life. The data reflect diverse socioeconomic backgrounds, geographic locations, and cardiovascular risk profiles, making the findings more applicable to Black women nationwide.
If these stressors contribute to heart failure risk, they may help explain why Black women develop the condition earlier and with more severe symptoms than White women. Traditional risk assessments focus on factors like hypertension, diabetes, and obesity but might overlook social and psychological contributors.
Health systems and insurers could use screening for racism and childhood trauma to identify higher-risk women. The study does not prove that addressing these factors would prevent heart failure. More research is needed to understand the biological pathways and whether interventions could reduce risk.
The team called for further studies to explore how these stressors interact with different types of heart failure, such as those with preserved versus reduced ejection fraction. They also highlighted the need to examine whether effects vary by age, socioeconomic status, or other social determinants of health.
Different aspects of psychosocial stress disproportionately experienced by Black women may signal raised heart failure risk beyond sociodemographic factors. Further research should investigate the biological pathways and how risk differs by heart failure type.
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