Deaths from heart attacks, strokes and other heart diseases have been declining, but social factors, including race, income, environment and education could reverse that trend according to a first of its kind scientific statement from the American Heart Association.
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, according to the statement, published in the association's journal Circulation.
"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:
Prenatal and early childhood development. Emerging evidence suggests that one's tendency to develop high blood pressure and perhaps diabetes as adults is in some way determined by things that happen before birth and through early life. There's evidence that children with low birth weight tend to have structural changes to the heart and kidneys that may predispose them high blood pressure and diabetes, when they're adults.
Also, a study found that preschool children in an enhanced daycare program, where they were educated, referred to a pediatrician and received healthy meals seemed to have lower risk for heart disease 30 years later compared to preschoolers in usual daycare. "There may be an opportunity to prevent adults' chronic illnesses by doing a better job of taking care of preschool kids," Havranek said.
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. Addressing the social influences, as well as biological and genetic influences, on cardiovascular health in America is necessary to achieve what the American Heart Association calls the inclusive "culture of health."
"Failure to address the social dynamic of cardiovascular disease will compromise the American Heart Association's 2020 Impact Goal to improve cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent," Havranek said.
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. These include a focus on a new kind of advocacy.
"We're used to public health programs that educate people to know their blood pressure or cholesterol numbers. 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," he said.
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