AHA Statement: Social Factors Critical in Fight Against CVD

Megan Brooks

August 04, 2015

Ignoring social factors such as education, income, and living environment could wipe out progress achieved in curbing deaths due to heart disease and stroke, the American Heart Association (AHA) said a first-of-a-kind scientific statement.

Death due to cardiovascular disease (CVD) in the United States has been declining since the 1970s, but the burden remains high, accounting for roughly 32% of all deaths in 2010, with many disadvantaged groups disproportionately affected, according to the statement, published online August 3 in 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," Edward P. Havranek, MD, chair of the writing group and professor of cardiology at the University of Colorado School of Medicine, in Denver, said in the release.

"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% while reducing deaths from cardiovascular diseases and stroke by 20%," Dr Havranek added.

New Kind of Advocacy

The statement provides a comprehensive overview of the "substantial body of work" showing the influence that social factors have on cardiovascular health. For example, the report notes that lower educational levels have been linked to premature death due to CVD and lower income has been associated with a higher risk for CVD.

The report also notes that race and poverty overlap in the United States and there is evidence that people who suffer "the chronic stressors, such as racism, might have higher blood pressure as a result," Dr Havranek said.

Research also suggests that where a person lives affects their risk for CVD. "We need to learn more about why that is, but contributing factors could include less access to healthy food, less opportunity for physical activity, higher stress levels with higher crime, noise, traffic, et cetera," Dr Havranek said.

Emerging evidence also links prenatal and early childhood factors to risk for hypertension and diabetes.

In the statement, "Social Determinants of Risk and Outcomes for Cardiovascular Disease," the AHA encourages health providers and consumers to pay attention to how social factors might affect cardiovascular health and recommends specific steps for improving social factors that could harm cardiovascular health. These include a focus on a new kind of advocacy.

"Although we have traditionally considered CVD the consequence of certain modifiable and nonmodifiable physiological, lifestyle, and genetic risk factors, we must now broaden the focus to incorporate a third arm of risk, the social determinants of health. Failure to demonstrate awareness of this third dynamic will result in a growing burden of CVD, especially in those with the least means to engage in the healthcare system," the statement reads.

"We're used to public health programs that educate people to know their blood pressure or cholesterol numbers," Dr Havranek added in the AHA news release. "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."

The statement also lists several directions for future research, including:

  • Creating standardized measures of social group categories that disaggregate the social determinants of health into modifiable risk factors and promote continued monitoring and study of the differences between and within these categories;

  • Conducting observational studies to examine the complex interactions between social factors in relation to cardiovascular health;

  • Prioritizing research that investigates the intergenerational transmission of social disadvantage and the subsequent cardiovascular health consequences;

  • Continuing to research psychosocial, behavioral, biological, and epigenetic pathways linking social and economic factors to cardiovascular outcomes and exploring the promise of epigenetics; and

  • Creating linguistically and culturally appropriate care for diabetes and other CVD risk conditions for Hispanics and other racial/ethnic minority groups shown to be at increased risk for CVD and assessing their effectiveness critically.

Circulation. Published online August 3, 2015. Full text

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