Nav: Home

Where you live could determine risk of heart attack, stroke or dying of heart disease

April 03, 2017

People living in parts of Ontario with better access to preventive health care had lower rates of cardiac events compared to residents of regions with less access, found a new study published in CMAJ (Canadian Medical Association Journal.

"Residents of high-rate regions were the least likely to receive certain preventive services, even though they had the highest rates of smoking and obesity and the lowest rates of dietary intake of fruits and vegetables," writes Dr. Jack Tu, lead author of the study and senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and Sunnybrook Schulich Heart Centre, with coauthors.

The study was conducted by the Cardiovascular Health in Ambulatory Care Research Team (CANHEART), a "big data" initiative created to improve heart health and quality of outpatient care in Ontario, Canada's most populous province.

The study examined regional variations within Ontario's 14 Local Health Integration Networks (LHINs) and divided the regions into 3 categories: LHINs with the lowest number of cardiovascular events (3.2-3.5 events per 1000 person-years), medium (3.9-4.7 events per 1000 person-years) and highest (4.8-5.7 events per 1000 person-years).

The researchers looked at 5.5 million adults between 40 and 79 years of age as of January 1, 2008, in Ontario with no previous cardiovascular disease and followed them for 5 years looking for heart attacks, strokes or cardiovascular-related deaths. The LHINS with the lowest number of events (Central, Mississauga Halton and Toronto Central) were located in the highly populated Greater Toronto Area. People in these regions visited family doctors more often, and were more likely to be screened for heart disease risk factors and had better control of high blood pressure compared with residents of higher event areas. These urban LHINs were also more ethnically diverse.

The LHINs with the highest event rates were in northern Ontario (North East LHIN and North West LHIN) the region with the lowest population density, as well as the North Simcoe Muskoka LHIN and Erie St. Clair LHIN. People in these LHINs were more likely to be obese, to smoke and to have the lowest dietary intake of fruits and vegetables.

"What we found was a striking variation in the rates of heart attack, stroke or cardiovascular-related death depending on which LHIN a person lived in. There was a clear division between the healthiest and least-healthy LHINs," says Dr. Tu.

The authors suggest that improving access to preventive care in regions with high rates of cardiovascular events might improve health outcomes.

"Our study suggests that, even in a country with a universal health insurance system, higher rates of preventive health care contribute to lower rates of CVD [cardiovascular disease] events at a regional level," the authors write. "Our findings provide new information that health system factors may be important contributors to regional variations in CVD event rates."

In a related commentary http://www.cmaj.ca/site/press/cmaj.170116.pdf, Dr. Genevieve Gabb from the Royal Adelaide Hospital and University of Adelaide, Australia, writes that regional variation in heart disease is seen in other countries, such as Australia.

"The solution to reducing variations in geographic incidence of primary cardiac events will not be found solely in addressing health service factors," she writes. "Consideration of public health measures and addressing inequalities in social determinants of health are also essential. Disease burden should be considered when determining resource allocation."
-end-
The study was conducted by researchers from ICES, Sunnybrook Schulich Heart Centre, St. Michael's Hospital, Women's College Hospital Institute for Health Systems Solutions and Virtual Care, and the University of Toronto, Toronto, Ontario; Bruyère Research Institute, The Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, Ontario; Western University of Health Sciences, Pomona, California.

The study was funded by an operating grant from the Institute of Circulatory and Respiratory Health and the Canadian Institutes of Health Research.

Canadian Medical Association Journal

Related Heart Disease Articles:

Where you live could determine risk of heart attack, stroke or dying of heart disease
People living in parts of Ontario with better access to preventive health care had lower rates of cardiac events compared to residents of regions with less access, found a new study published in CMAJ (Canadian Medical Association Journal).
Older adults with heart disease can become more independent and heart healthy with physical activity
Improving physical function among older adults with heart disease helps heart health and even the oldest have a better quality of life and greater independence.
Dietary factors associated with substantial proportion of deaths from heart disease, stroke, and disease
Nearly half of all deaths due to heart disease, stroke, and type 2 diabetes in the US in 2012 were associated with suboptimal consumption of certain dietary factors, according to a study appearing in the March 7 issue of JAMA.
Certain heart fat associated with higher risk of heart disease in postmenopausal women
For the first time, researchers have pinpointed a type of heart fat, linked it to a risk factor for heart disease and shown that menopausal status and estrogen levels are critical modifying factors of its associated risk in women.
Maternal chronic disease linked to higher rates of congenital heart disease in babies
Pregnant women with congenital heart defects or type 2 diabetes have a higher risk of giving birth to babies with severe congenital heart disease and should be monitored closely in the prenatal period, according to a study published in CMAJ.
Novel heart valve replacement offers hope for thousands with rheumatic heart disease
A novel heart valve replacement method is revealed today that offers hope for the thousands of patients with rheumatic heart disease who need the procedure each year.
Younger heart attack survivors may face premature heart disease death
For patients age 50 and younger, the risk of premature death after a heart attack has dropped significantly, but their risk is still almost twice as high when compared to the general population, largely due to heart disease and other smoking-related diseases The risk of heart attack can be greatly reduced by quitting smoking, exercising and following a healthy diet.
Citrus fruits could help prevent obesity-related heart disease, liver disease, diabetes
Oranges and other citrus fruits are good for you -- they contain plenty of vitamins and substances, such as antioxidants, that can help keep you healthy.
Gallstone disease may increase heart disease risk
A history of gallstone disease was linked to a 23 percent increased risk of developing coronary heart disease.
Americans are getting heart-healthier: Coronary heart disease decreasing in the US
Coronary heart disease is one of the leading causes of death in the United States.

Related Heart Disease Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Jumpstarting Creativity
Our greatest breakthroughs and triumphs have one thing in common: creativity. But how do you ignite it? And how do you rekindle it? This hour, TED speakers explore ideas on jumpstarting creativity. Guests include economist Tim Harford, producer Helen Marriage, artificial intelligence researcher Steve Engels, and behavioral scientist Marily Oppezzo.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".