For Elston Harris, heart attacks seem to be a generational curse.

Several men from his father’s side of the family — including Harris’ uncles — died from heart attacks. Harris, who is 59 and a former college basketball player, almost experienced a similar fate after his own heart attack in 2017. The only signs he was having a heart attack that he noticed were “small” symptoms of back pain and trapped gas.

For Harris, the curse may have been a blessing in disguise: While being treated at Advocate Trinity Hospital, a medical center in southeast Chicago, he was referred to Dr. Marlon Everett, a cardiologist who gave him a “game plan” to follow. This included putting God first, eating healthy and concentrating on his checkups. But aside from Everett’s expertise, Harris said he felt comfortable because Everett looked like him.

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“When you are African American or Black, you’re more comfortable interacting with someone who knows, ‘OK, he might have grew up here, or he might eat this, or I heard them do that,’” said Harris, who lives in Chicago. “So, you’re a lot more comfortable with people who walk in similar footsteps.”

Around 60% of Black American adults have heart disease, and heart disease death rates are highest among Black Americans compared to other racial and ethnic groups, according to the American Heart Association.

Yet Harris’ experience of having a cardiologist who looks like him is a rarity. A 2021 report by the Association of American Medical Colleges found that only 4.2% of cardiologists are Black. An earlier study, published in 2019 in the journal JAMA Cardiology had similar findings, revealing that Black doctors made up only 3% of the cardiologist workforce. That same report found that 51% of cardiologists were white and 19% were Asian.

Increasing the number of Black cardiologists could mean better heart health for Black patients.

“Underrepresented medical professionals are more likely to practice in their communities where cultural sensitivity can create trust and their presence have been shown to improve outcomes,” the AHA said in a statement to NBC News. “This connection is particularly important among Black Americans when it comes to heart health.”

Why are there so few Black cardiologists?

Dr. Mary Branch, a cardiologist based in Greensboro, North Carolina, said she first became interested in cardiology nearly 20 years ago, after shadowing a white interventional cardiologist who was “very accepting of me,” she said. The path to cardiology is onerous, and includes four years of medical school, three years of internal medicine residency and three years of a cardiology fellowship, in addition to several board exams, she said, which can be a difficult path to follow.

Branch, a fourth-generation physician, said her path also included financial strain and discrimination — hurdles that are all too common for Black medical students and among the reasons, she said, why there are so few Black doctors in cardiology.

Branch was the first Black woman to enter the cardiovascular disease fellowship at the Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. At one point during her fellowship, she said, she lived in a hotel while trying to find secure housing.

Even without a place to stay, Branch said she was “still showing up” at her fellowship. “Really, it was just God saying you’re needed,” she said. “So, we got to keep going. But that meant a lot of hard choices.”

Many Black medical students can also experience harsh microaggressions, which can prevent them from becoming a cardiologist, Branch said.

The margin of error can be “very small” for Black trainees, she said. While most medical students and residents of all races perceived high levels of mistreatment, Black people perceived more stress in medical school than white people, according to a 2006 study in the Journal of the National Medical Association. The perceived stress stemmed from their minority status and experiences of racial discrimination in training.

A 2021 study in the Journal of General Internal Medicine found that the proportion of Black doctors in the U.S. had increased by only 4 percentage points over the last 120 years. The study also found that the share of Black male doctors remained the same since 1940. While there’s little data on the rates of Black women in cardiology, Black women make up only 2.8% of the physician workforce, according to a 2021 perspective in The Lancet.

Everett, who is a member of the Association of Black Cardiologists, a national organization bringing attention to the harmful impact of heart disease on Black people, cited a lack of adequate training programs for doctors who want to be cardiologists. Most cardiology programs may only have three or four cardiology training positions, but “we’re just not getting those training positions,” he said.

“Until there are programs that are mandating that there’s diversity in training programs, we’re never going to have a lot of inclusivity, especially in the sought-out training programs … such as cardiology,” Everett added.

The organization also plays a role in recruiting Black patients for clinical trials, which have low numbers of Black participants. A 2021 study published in the Journal of the American Heart Association found that Black adults were underrepresented in cardiovascular trials funded by the National Institutes of Health.

That can mean that doctors don’t have the best available information on how to treat Black patients.

“It’s very important to have a lot of Black patients in trials, so we can get better data — and more data means better information, and hopefully better outcomes,” Everett said.

‘A sense of comfort’

For many Black patients, having a Black cardiologist creates feelings of trust and comfort, which is sometimes a challenge due to the medical system’s history of racism and mistreatment toward Black patients.

Nikita Oxner first saw Branch last year after doctors discovered she had a heart murmur that they detected during a sleep study. Oxner, 45, said up until that point, she had never sought care from a cardiologist, and even being referred to one was “scary.” Yet her fears subsided when she met Branch.

Under Branch’s care, Oxner discovered she had a condition that makes it difficult for the heart to pump blood.

Heart-related problems run in Oxner’s family. In 2019, hypertension led to her brother’s sudden death at age 31, and her grandmother died from heart disease at age 77. Her father, who died from cancer at age 39, “had hypertension, high blood pressure a majority of his life,” she said.

Oxner said that when she shared details about her brother and other family members to Branch, “she instantly understood.” While she “didn’t feel good” about having surgery to insert a defibrillator in her heart, Oxner trusted her doctor’s opinion.

“She had a lot of compassion,” said Oxner, who lives in Greensboro, North Carolina. “She was very understanding, down to earth and relatable — and really helped me understand how this could change my life.”

As a Black woman who often has to advocate for her health, Oxner said the fact that Branch was also a Black woman “mattered to me.”

Branch said the added layer of trust and comfort often seen between a Black patient and Black doctor can help motivate patients to stay on their heart medications and stick with healthy lifestyle changes.

For example, “hypertension is a big thing in our community,” she said. A Black cardiologist may also be on hypertension medication, she said, “so, they can relate and connect in that way.”

Like Oxner, Kia Smith, 42, is another Black woman who sought cardiac care from a Black physician. Smith, who lives in Ellenwood, Georgia, said she saw Dr. Camille Nelson, a cardiologist at Atlanta Heart Associates, in 2020 after experiencing an elevated heart rate. Smith said she believes that if she had chosen a non-Black cardiologist, she may have been treated like “a dramatic walk-in” and had her symptoms dismissed.

“At every turn, when I was concerned, she did not dismiss my concerns or my personal experiences,” Smith said of Nelson. “She also explained the science of everything to me, and we were able to get to a place where I was confident that I was going to be OK.” Nelson said that Smith’s symptoms may have stemmed from stress and recommended workout routines to get her heart into a healthier state.

Dr. Zainab Mahmoud, a cardiologist and instructor of medicine at Washington University in St. Louis, said many Black women tell her that they feel heard and understood under her care. Having a provider who can understand a Black patient’s experiences “creates this kind of trust and improves a patient-provider relationship,” she said.

“They’re more likely to then have their family members come or their family and friends come to see me as well,” Mahmoud added. “I’ve seen that happen multiple times I can’t even count.”

Getting more Black doctors into cardiology

Increasing the number of Black cardiologists has been the focus of major health organizations in recent years.

The AHA’s scholars program provides cardiology resources for Black students from historically Black colleges and universities, where more than 70% of Black medical professionals earn their degrees.

The organization is also focusing on broader efforts: A strong education can help grow the next generation of Black doctors, nurses and researchers, it said in a statement. One major goal is to increase the number of Black students in graduate science, research and public health programs.

Like the AHA, the American College of Cardiology also implemented diversity efforts through its internal medicine program to introduce Black, Latino and other underrepresented groups into cardiology.

“The problem is, it’s not just cardiology,” said Dr. Melvin Echols, the ACC’s chief diversity, equity and inclusion officer. “It’s all of health care. You see a significant, very low rate of African American doctors. I think what we’re trying to do is make it easier, No. 1, for people to actually get information and get resources.”

Harris, who survived his 2017 heart attack, said it was “through God’s grace” that he ended up at Advocate Trinity Hospital when his life was on the line — with a cardiologist he could trust.

“He was there during my episode and we immediately formed a relationship after that,” Harris said of his cardiologist Everett. Harris has been under his care “ever since.”