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 from Brightsurf:

Mechanism linking gum disease to heart disease, other inflammatory conditions discovered
The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery.

New 'atlas' of human heart cells first step toward precision treatments for heart disease
Scientists have for the first time documented all of the different cell types and genes expressed in the healthy human heart, in research published in the journal Nature.

With a heavy heart: How men and women develop heart disease differently
A new study by researchers from McGill University has uncovered that minerals causing aortic heart valve blockage in men and women are different, a discovery that could change how heart disease is diagnosed and treated.

Heart-healthy diets are naturally low in dietary cholesterol and can help to reduce the risk of heart disease and stroke
Eating a heart-healthy dietary pattern rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, vegetable oils and nuts, which is also limits salt, red and processed meats, refined-carbohydrates and added sugars, is relatively low in dietary cholesterol and supports healthy levels of artery-clogging LDL cholesterol.

Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.

Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.

New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.

Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.

Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.

Women once considered low risk for heart disease show evidence of previous heart attack scars
Women who complain about chest pain often are reassured by their doctors that there is no reason to worry because their angiograms show that the women don't have blockages in the major heart arteries, a primary cause of heart attacks in men.

Read More: Heart Disease News and Heart Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.