Heart Health: What's Missing in Global Advice

 

Exercise and dietary guidance often falls short in enhancing global heart health

Stay active and enjoy your greens: For much of the world, affluent advice like this doesn't consistently lower heart disease risk.

Cardiovascular disease (CVD) holds the title of the foremost cause of mortality worldwide, with 80% of fatalities occurring in low- and middle-income nations. Nevertheless, global heart-health guidelines predominantly draw from studies conducted in wealthier countries and frequently neglect fundamental factors contributing to CVD, states Scott Lear, a professor of health sciences at SFU in partnership with the Pfizer/Heart & Stroke Foundation Chair is focusing on Cardiovascular Prevention Research.

"When we consider universal recommendations such as 75 minutes of exercise each week or consuming five servings of fruits and vegetables daily, it’s essential to remember that the world extends beyond affluent nations," says Lear, the lead author of a new review exploring the influence of social, environmental, and policy elements on cardiovascular disease worldwide.

"There's a striking difference between a casual stroll along Vancouver's West End and the daily trek to work in New Delhi, the most polluted city on the planet, where many citizens cannot afford a vehicle and public transport is inadequate," he continues. "It’s important to recognize that life varies in different places." The surroundings in which individuals reside and the nature of their work significantly impact their health."

The review article investigates the fundamental reasons for cardiovascular disease (CVD), using insights from the ongoing Prospective Urban Rural Epidemiology (PURE) project. Since 2002, this study has been amassing information from high-, middle-, and low-income countries, now encompassing over 212,000 participants from 28 nations across five continents.

 Every three years, the PURE study collects data through a main survey, measuring physical attributes like height, weight, blood pressure, waist-to-hip ratio, and lung function, along with additional questionnaires. concentrating on specific research interests like CVD.

Beyond physical activity contexts, Lear's review has identified several other underlying causes of CVD worldwide, including nutrition, education, tobacco consumption, air quality, climate change, social isolation, and accessibility to medications, treatments, and healthcare.

Approximately 87% of PURE participants reside in low- or middle-income nations, uniquely enabling the study to investigate individual risk factors linked to urban development, remarks Lear. While these review conclusions are founded on global data, they also mirror the microcosms of distinct areas within a single city or region.

Privilege influences physical activity

Insufficient exercise is a significant risk element for cardiovascular disease, yet the type and context of physical activity individuals engage in also contribute.

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Lear's review indicates that self-reported levels of physical activity were highest in affluent countries, even though over 22% of participants reported sitting for more than eight hours daily. In contrast, only 4.4% of individuals in low-income nations reported prolonged sedentary behavior, while their overall physical activity levels were lower.

The distinction lies within the quality of activity. In low-income countries, physical activity is often associated with labor, transport, and household chores rather than recreational pursuits, as Lear points out.

Out of reach for fresh produce

 A healthy diet rich in fruits, vegetables, legumes, nuts, fish, and dairy products can reduce the risk of cardiovascular disease.. Lear found that, irrespective of national income, fruits and vegetables were more accessible and affordable in urban locales.

However, he was also taken aback to discover that fruit and vegetable consumption is lower in low-income countries because farmers cannot afford to consume their own produce.