By: Lucaiah Smith-Miodownik, News Writer
Scott Lear is a professor of health sciences at SFU and the Pfizer/Heart and Stroke Foundation chair in Cardiovascular Prevention Research at St. Paul’s Hospital. He recently published a study with other researchers from around the world, examining determinants of cardiovascular disease (CVD). CVD (also known as heart disease) is related to atherosclerosis, which is the buildup of plaque in arteries, making it harder for blood to flow. Study findings offered new perspectives on combating CVD, while challenging the status quo on current global health guidelines for maintaining cardiovascular wellness.
Lear’s study was unique in examining CVD in low- and middle-income countries (LIC, MIC) rather than generalizing findings from high-income countries (HIC) to create universal guidelines. Prior to this research, much of the understanding regarding the effect of “environmental and social exposures and policies” on CVD came from sampling HICs only.
According to the study, LIC and MIC have “poorly funded health systems, poor access to prevention and treatment strategies,” and “a higher prevalence of chronic disease.” Worldwide, ischemic heart disease, a specific type of CVD, is the leading cause of death due to numerous individual and societal factors. From 2000 to 2021, the number of deaths climbed by 2.7 million to reach 9.1 million, per the World Health Organization. Other types of CVD include strokes, heart attacks, and more. According to an SFU press release on the new study, 80% of CVD deaths come from LIC and MIC.
By using data from the Prospective Urban and Rural Epidemiological (PURE) study and related studies, Lear’s study was designed to shape “future policy and research recommendations” and “accelerate the reduction of the global burden of CVD.” Specifically, his team highlighted findings from previous studies, which showed that individual biological and behavioural risk factors are influenced by social, environmental, and policy determinants, such as the walkability of one’s environment, tobacco price, and food accessibility. PURE conducts research about “CVD, diabetes, kidney and lung diseases, brain health, cancer, and more” internationally. The PURE study utilized data from 28 countries, with 87% of participants living in LIC or MIC. It includes statistics on various measures of health, including physical activity, diet, healthcare accessibility, social isolation and cohesion, and more.
“We cannot assume that life is the same everywhere. The environments in which people live and the kind of work they do makes a huge difference to their health,” — Scott Lear, professor of health sciences and Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research
One takeaway from the PURE data was that “physical inactivity was the second strongest behavioural determinant of CVD after tobacco use.” However, while HIC residents spent more time partaking in recreational activities, those living in LICs reported higher rates of non-recreational activity, such as manual labour involving lifting things, walking to work, and doing household chores. Additionally, “only 4.4% of LIC participants reported sitting more than eight hours a day compared with 22.2% of HIC participants.” Lear’s team showed that measuring physical activity only by recreation omits significant context and details.
In terms of food, “while the absolute cost of fruits and vegetables was lowest in LIC, the cost relative to income was 50 times greater for fruits and 19 times greater for vegetables than in HIC.” Accordingly, HIC reported a greater mean consumption of fruits and vegetables than LIC. When we suggest that individuals “eat better” as a CVD guideline, the study recommends we must also recognize “the context of the local environment,” as well as “facilitators and barriers.”
Other recommendations include focusing more on “population-level measures to make healthy choices easier.” Additionally, the study emphasizes the importance of “enhancing collaborations between researchers with diverse backgrounds,” and “awareness of barriers to evidence-based health policies, including commercial determinants of health such as obstruction by vested interests.”
The biggest takeaway? “Success can only come through engagement of multiple sectors and countries beyond HIC,” reports the study. “We cannot assume that life is the same everywhere,” Lear said in the SFU press release. “The environments in which people live and the kind of work they do makes a huge difference to their health.”
