ROCHESTER, Minn. — A research study of African Americans with cardiovascular disease suggests religious practices and spirituality may contribute to heart health. The study's authors assert that recognizing the importance of religious practices and spirituality in the lives and health of African Americans may be key to improving patient care and reducing heart health disparities in African American communities.

African Americans are disproportionately affected by cardiovascular disease, compared to the general population. Those differences are driven by underlying cardiovascular risk factors, as well as social and economic inequality, according to a report from the American Heart Association.

"I would encourage health care professionals to initiate dialogue about religiosity and spirituality with their patients as part of comprehensive social history taking and patient-centered approaches to health care delivery," says LaPrincess Brewer, M.D., a Mayo Clinic preventive cardiologist and first author on the study. "I would also encourage researchers to consider these factors when designing heart health interventions."

This study was part of the larger Jackson Heart Study, a community-based epidemiologic study of environmental and genetic factors associated with cardiovascular disease among African Americans in Jackson, Mississippi. Details about the Jackson Heart Study design and recruitment, which were previously published, are on the study's website.

Participants completed interviews and surveys assessing a wide range of social and cultural factors, including heart health, and religious practice and spirituality:

• Heart health was assessed according to the American Heart Association Life's Simple Seven model, focusing on seven components of heart health: diet, physical activity, smoking, body mass index, blood pressure, cholesterol and glucose.
• Religious practices were assessed according to levels of religious attendance, private prayer and religious coping to difficult life situations or stressful events.
• Spirituality was assessed focusing on three domains related to theistic spirituality — feel God's presence, desire closer union with God, and feel God's love — and three domains related to nontheistic spirituality —feel strength in my religion, feel deep inner peace and harmony, and feel spiritually touched by creation.

Among the 2,967 participants, higher levels of religious practices were associated with greater likelihood of intermediate or ideal levels of heart health across multiple Life's Simple Seven components. Higher levels of religious practices or spirituality were associated with greater likelihood of intermediate or ideal smoking status — quitting or never smoking. In addition, some specific domains of religious practices or spirituality were associated with certain elements of heart health. For example, private prayer was associated with intermediate or ideal levels of diet and smoking, and nontheistic spirituality was associated with greater odds of intermediate or ideal physical activity and smoking.

"The cultural relevance of heart health interventions is especially important for socioeconomically disenfranchised communities faced with a plethora of challenges and stressors," says Dr. Brewer. "Religiosity and spirituality may serve as buffers to stress and have therapeutic effects or may empower people to practice healthy behaviors or seek preventive health services."

However, researchers caution against drawing causal relationships between religious practices or spirituality and heart health. In this study, higher levels of religious practices or spirituality were more closely associated with modifiable risk factors, such as diet and physical activity, than with biological measures, such as cholesterol or weight. This could reflect underreporting of certain behaviors or various other influences.

The researchers indicate that next steps in this research involve larger studies to assess religious practices and spirituality on public and population health levels. The goal is to use this information to improve heart health treatments and outcomes for diverse populations.

Mario Sims, Ph.D., is the senior author on this study. He is a social epidemiologist at The University of Mississippi Medical Center and chief science officer for the Jackson Heart Study.

This study was supported by Clinical and Translational Science Award grant UL1 TR000135 and grant KL2 TR002379 from the National Center for Advancing Translational Sciences, Mayo Clinic's Center for Health Equity and Community Engagement Research, the American Heart Association's Amos Medical Faculty Development Program grant 19AMFDP35040005, the National Institute on Minority Health and Health Disparities grant 1 R21MD013490-0, and Centers for Disease Control and Prevention grant CDC-DP18-1917.

The authors report no conflicts of interest.

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