A leading cardiovascular researcher at Simon Fraser University is issuing a critical warning about the limitations of current universal heart-health recommendations. Despite cardiovascular disease (CVD) being the leading global cause of death, with a staggering 80% of fatal cases occurring in low- and middle-income countries, prevailing guidelines are largely derived from studies conducted in high-income regions. This discrepancy, says Scott Lear, an esteemed health sciences professor and Chair in Cardiovascular Prevention Research, raises serious concerns about the applicability of these recommendations worldwide.
Scott Lear’s recent systematic review, published in the European Heart Journal, scrutinizes the broader social, environmental, and policy determinants of cardiovascular disease across diverse populations. The review emphasizes that the standard prescriptions—such as engaging in at least 75 minutes of moderate exercise per week or consuming five servings of fruits and vegetables a day—do not universally translate into effective strategies. He highlights a fundamental dichotomy in daily living conditions across the globe, underscoring that a leisurely stroll in the urban neighborhoods of cities like Vancouver is not comparable to the physical experiences of inhabitants in highly polluted cities like New Delhi, where socioeconomic factors compel walking as a necessity rather than a choice.
The systematic review draws extensively on data from the Prospective Urban Rural Epidemiology (PURE) study, an extensive international cohort project that has tracked over 212,000 participants from 28 countries representing low-, middle-, and high-income brackets since 2002. PURE’s longitudinal data collection includes a comprehensive core survey alongside physical measurements such as anthropometrics, blood pressure, and lung function, enriched periodically with tailored questionnaires addressing cardiovascular risk factors. The study’s unique design provides a rare lens into the environmental and social variables influencing CVD beyond traditional biomedical markers.
Lear stresses the profound effect of upstream determinants—factors that precipitate direct risk behaviors or biological changes influencing disease. His review uncovers how these determinants encompass an array of influences like nutritional quality, educational attainment, tobacco usage, ambient air pollution, macro-environmental phenomena including climate change, social connectivity, and crucially, equitable access to healthcare services and medications. These elements coalesce differently across various economic settings, reshaping the epidemiological landscape of cardiovascular disease.
A striking insight from the analysis is the complex relationship between physical activity and socioeconomic context. Paradoxically, self-reported physical activity levels are highest in affluent countries where sedentary lifestyles prevail, exemplified by over 22 percent of people sitting for more than eight hours daily. In contrast, individuals in lower-income countries exhibit lower physical activity levels despite spending significantly fewer hours sedentary. This paradox is explained by the nature of activity; physical exertion in these settings frequently arises out of occupational labor, transportation demands, and household chores rather than deliberate leisure exercise, which dominates in wealthier populations.
Such findings challenge the assumption that simply increasing exercise time uniformly reduces CVD risk worldwide. Contextual physical activity—its type, intensity, and environment—must be considered when formulating guidelines. For instance, the dangers of walking in heavily polluted urban centers outweigh the cardiovascular benefits that might accrue in cleaner environments, raising questions about the universal promotion of outdoor exercise.
Nutrition is another domain where global inequities play a decisive role. While fruits and vegetables are generally more available and affordable in urban locations independent of a country’s economic status, the actual consumption patterns diverge starkly. Lear’s review highlights an astonishing reality: many farmers in low-income countries, despite producing healthy crops, cannot afford to consume sufficient quantities themselves. This paradox reveals that adhering to the recommended five daily servings of fruits and vegetables could demand up to half of a farming household’s income, rendering healthy diets economically unattainable for large swaths of the population.
This revelation calls for a paradigm shift in public health nutrition policies, pushing beyond availability towards affordability and equitable distribution. Addressing these systemic barriers requires integrating economic policies with health interventions to alleviate the financial strain on vulnerable populations, ensuring that nutritional guidelines are feasible and culturally appropriate.
Social factors such as isolation and inadequate healthcare infrastructure emerge as additional layers of complexity in the global cardiovascular risk profile. The review details how social connectedness and universal access to treatment and preventive healthcare are pivotal in mitigating CVD outcomes, yet these components remain unevenly distributed. Therefore, strategies aiming to reduce cardiovascular disease must encompass policy reforms designed to improve healthcare accessibility and social support networks.
Air pollution and climate change represent environmental determinants with escalating relevance to cardiovascular health. The exposure to fine particulate matter and other pollutants contributes markedly to vascular inflammation and subsequent cardiac events. Lear’s synthesis underscores the urgency of integrating environmental health initiatives with cardiovascular prevention campaigns, particularly in rapidly urbanizing regions experiencing surges in pollution levels.
Collectively, these findings caution against the oversimplification of cardiovascular disease prevention goals and advocate for tailored interventions that consider the heterogeneous realities of global populations. The environmental, economic, and social contexts substantially modify both risk factors and potential intervention outcomes, necessitating localized research and policy adaptation.
Finally, the PURE study’s robust, globally representative data underpin this reframing of cardiovascular health paradigms, positioning it as a cornerstone in understanding the “causes behind the causes” of cardiovascular disease. Researchers and policymakers are urged to move beyond standardized prescriptions and craft nuanced, multifactorial, and equity-focused approaches to combat the leading killer worldwide.
With cardiovascular mortality tightly intertwined with socio-economic disparities and environmental contexts, the path forward lies in transcending biomedical models to embrace a holistic public health framework that places people’s lived realities at the center of prevention strategies.
Subject of Research: People
Article Title: Social factors, health policy, and environment: implications for cardiovascular disease across the globe
News Publication Date: 22-Apr-2025
Web References: http://dx.doi.org/10.1093/eurheartj/ehaf212
References: Lear S.A. et al. European Heart Journal, DOI: 10.1093/eurheartj/ehaf212
Keywords: Health care, Health equity, Health care policy, Physical exercise, Environmental health, Health disparity
