While deaths from heart attacks, strokes and other heart diseases have been declining, that trend could reverse if social factors, including race, income, environment and education are not addressed, the American Heart Association said in a “first of its kind scientific statement” published in the association’s journal Circulation and released Aug. 3.
AHA said that advances in prevention and treatment have driven the decline in cardiovascular deaths, but the benefits have not been shared equally across economic, racial, and ethnic groups in the United States.
“The steady decline of death from cardiovascular disease that began in the 1970s might be coming to an end. Overall population health cannot improve if parts of the population do not benefit from improvements in prevention and treatment,” said Edward P. Havranek, M.D., chair of the writing group and a cardiologist at Denver Health Medical Center and professor of cardiology at the University of Colorado School of Medicine, Denver, Colorado.
Social determinants include circumstances in which people are born, grow, live, work and age. The statement notes several areas in which clear associations between societal factors and cardiovascular health have been shown. Among those, as stated by AHA:
Education is a top indicator of one’s socioeconomic status because it affects what kind of job a person has, access to healthcare, income, stress and more. Research indicates that people with lower educational levels die younger, largely due to cardiovascular disease, according to Havranek.
The lower the income, the higher the risk for cardiovascular disease. In one study of more than 500,000 men, researchers found a 40 percent to 50 percent decrease in risk of cardiovascular death, with increasing levels of family income.
There is overlap between race and poverty in the United States, which is especially evident among African-Americans. While some differences in cardiovascular risk among races might be explained by genetics and biology, there are other factors.
Whether bias and prejudice lead to less care or poorer care is a question that people are actively studying, Havranek said.
There also is evidence that people who experience the chronic stressors, such as racism, might have higher blood pressure as a result and that neighborhoods have an effect on heart disease risks, AHA noted.
Contributing factors could include less access to healthy food, less opportunity for physical activity, higher stress levels with higher crime, noise and traffic, Havranek said.
AHA also cited prenatal and early childhood development and access to health care and insurance.
The number of cardiovascular disease cases in the United States is expected to rise about 10 percent between 2010 and 2030. The social dynamic of cardiovascular disease is helping to drive the increase, according to the statement.
The statement suggests doctors and consumers pay attention to how social factors might impact cardiovascular health and recommends specific steps for improving social factors that could negatively impact cardiovascular health.
“We’re used to public health programs that educate people to know their blood pressure or cholesterol numbers.” Havranek said. “We’re less comfortable with public health programs focused on getting three-year-olds into daycare programs, which may improve their health down the road. We might be less accustomed to (but need) public health programs that look at how urban planners can improve neighborhoods that are seeing higher rates of cardiovascular disease.”