0730-Feature-Social Factors_Blog

Although deaths from heart attacks and strokes have been declining thanks to advances in prevention and treatment, social factors such as race and income could reverse that trend, according to a first-of-its-kind statement from the American Heart Association.

The incidence of heart disease and stroke in the United States is expected to rise 10 percent by 2030, with the circumstances in which people are born, grow, live, work and age all partly to blame, the statement said.

African-Americans are two to three times more likely to die from heart disease than whites, according to the latest statistics from the AHA. African-Americans and other racial and ethnic minorities also have higher rates of premature death from cardiovascular diseases and are at higher risk for high blood pressure and other risk factors for heart disease and stroke.

Edward P. Havranek, M.D., chaired the statement’s writing group and said the nation’s overall health will not improve if some segments of the population do not benefit from improvements in prevention and treatment.

“We have had a steady decline from mortality in heart disease since the 1970s. That’s something we take for granted, but we can’t. Further gains in heart health might not happen,” Havranek said.

Years ago, Havranek, a cardiologist at Denver Health Medical Center and professor of cardiology at the University of Colorado School of Medicine, started seeing patients in their 40s who had a severity of heart disease he used to see only in patients in their 60s. “It made me wonder, ‘What the heck is going on?’ ” he said.

The statement’s writing panel wanted to find out.

Research showed that people with lower educational levels die younger, largely from cardiovascular disease, Havranek said. Lower income can also lead to higher risk. In one study of more than 500,000 men, researchers found the risk of cardiovascular death dropped dramatically as family income rose.

Race, environment, prenatal and early childhood development and access to health care can also have a big impact. More than 16 million uninsured people gained coverage through the Affordable Care Act, so access could improve significantly, Havranek said.

“But we still need to have a healthcare system that is welcoming to people who might fall into lower socioeconomic groups, where people can find primary care doctors and can get timely care,” he said.

His advice for doctors and consumers: Pay attention.

“Just as we take medical histories and look at patients’ blood pressure and cholesterol numbers to measure heart disease risk, we should consider where patients live and what kinds of disadvantages they might face based on income, education and ethnicity, and how we can help them engage in the healthcare system,” Havranek said.

Starting with prenatal and children’s care could be critical. Havranek points to a 1970s study that looked at an enhanced daycare environment in children up to age 4. They were in daycare with educational opportunities, nutritious meals and access to a pediatrician. When researchers revisited those people in their 30s, they found that some groups who had received enhanced daycare were more likely to have their blood pressure and cholesterol under control, and more likely to have health insurance.

It illustrates a need for public health programs that Americans may not be accustomed to, Havranek said.

“We’re used to public health programs that educate people to know their blood pressure or cholesterol numbers,” he said. “We’re less comfortable with public health programs focused on getting 3-year-olds into daycare programs, which may improve their health down the road.”

Getting rid of the message of doom — for example, thinking that if you grew up in a disadvantaged neighborhood, you’re doomed to heart disease — could also improve long-term health, he said.

“You should take care of yourself more, not less, and work with neighbors and friends and family to collectively strive for better health,” Havranek said.