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The Hidden Causes of Cardiovascular Disease

While one might imagine cancer, COVID-19, or dementia to be the leading cause of death in America, the answer is none of the above — rather, the deadliest disease is that of the heart. Each day, on average, one person dies every 34 seconds from cardiovascular disease [1].


Cardiovascular disease (CVD) is an umbrella definition for various different disorders affecting the heart and blood vessels; it can include anything from heart disease to stroke [2]. This might seem like common knowledge, but when reflecting upon my personal awareness of cardiovascular diseases, I cannot recall learning much about it in school. I received much more education about other illnesses, such as cancer. I remember countless commercials from St. Jude Children’s Hospital, garnering attention for childhood cancer, and I remember wearing pink in support of breast cancer survivors. In contrast, there was never a time when American Heart Association events were celebrated.


Among college students, my experience with education on CVD is not unique. One study done on the awareness of heart disease among college students reported that, generally, they knew less about its risk factors and impacts, suggesting that education on the illness should be improved [3]. While, of course, cancer awareness is by no means a bad cause to support, the disproportionality between education of cancer and heart disease is stark and deserves critical analysis.


The discrepancies between cancer and heart disease awareness lie within the communities that they affect. Studies have found that cancer is more likely to affect those living in urban communities, whereas heart disease affects those in rural environments [4]. Rural communities face unique challenges when contrasted with their urban counterparts, as the culture differs starkly between these communities. A study by Monroe et al. found that the significant income disparity between people living in rural versus urban areas might lead to greater risk for chronic diseases, like diabetes and heart disease, for rural populations, which they attribute to the well-established inverse relationship between socioeconomic status and the prevalence of these diseases [4].


Risk factors for heart disease extend much further than bad lifestyle habits. Socioeconomic disparities in cities are important factors as well, but rural populations often face the unique challenge of immense physical distance from the nearest doctors and other sources for essential needs like healthy food. Rural Southern communities, particularly, hold unhealthy eating habits within the gastronomic culture. The majority of diets consist of greasy, fast food— the overconsumption of which has been linked to development of heart disease, as supported by research from O’Connor and Wellenius [5]. These types of foods increase plaque build up in the arteries, increasing risk for CVD. In a study, they found that prevalence rates of diabetes and coronary heart disease were 8.6% (P = 0.001) and 38.8% (P < 0.001) higher among respondents living in rural areas, compared with urban areas, respectively. Common risk factors for these conditions— including poverty (P < 0.001), obesity (P < 0.001) and tobacco use (P < 0.001) — are higher in rural communities, potentially contributing to these findings [5]. Not only does this evidence suggest that heart disease is more prevalent in rural areas, but it provides reasons behind this trend.


Thus, finding a so-called ‘cure’ to CVD would require more than just a new, groundbreaking drug— it would need a complete overhaul of the systemic disadvantages present within these populations. Studies have found that taking a community based approach to combating cardiovascular disease is effective, but these trials are mainly individual based and are not promising for fixing the problem in its entirety [6]. Others argue that drug treatment is the best, citing preventing hypertension and blood clots before they lead to more serious disorders like a heart attack. Again, though, this is not a reflection of the disadvantaged populations that lack adequate access to medicine. One solution that specifically addresses the socioeconomic effects of cardiovascular disease is through policy work.


As aforementioned, one leading cause of cardiovascular disease lies within eating habits. Populations that lack access to the recommended amount of fruit and vegetable consumption, like those living in financially burdened rural areas, are at a higher risk of heart disease. Research done has proved that a national effort towards altering dietary policies would benefit those at a greater risk. Generally, it was found that just a 10% national subsidy to reduce fruit and vegetable prices could delay, or all together eliminate, approximately 150,000 CVD related deaths [7]. In terms of socioeconomic disparities, the greatest reduction was found within a targeted policy effort reducing fruit and vegetable prices for Supplemental Nutrition Assistance Program (SNAP) participants by 30%. This policy showed the greatest success in both decreasing cardiovascular related deaths and lessening already present wealth gaps that contribute to higher risk of CVD.


So, what can we do? In the aftermath of one of the most divisive midterms of this decade, it seems imperative to emphasize the importance of exercising your right to vote. This refers to not only just voting, but also voting for candidates that prioritize equal access healthcare and are committed to enacting policies that make people healthier. Research has proven that communities with higher civic participation and voting policies directed toward equality are overall healthier than their counterparts [8]. To become further involved, everyone has the right to contact their local senators or representatives to demand action taken to decrease cardiovascular disease in their community.


References

1. Centers for Disease Control and Prevention. (2022, July 15). Heart disease facts. Centers for Disease Control and Prevention. Retrieved September 18, 2022, from https://www.cdc.gov/heartdisease/facts.htm

2. World Health Organization. (2021). Cardiovascular diseases (cvds). World Health Organization. Retrieved November 9, 2022, from https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

3. Collins, K. M., Dantico, M., Shearer, N. B. C., & Mossman, K. L. (2004). Heart disease awareness among college students - journal of community health. SpringerLink. Retrieved September 18, 2022, from https://link.springer.com/article/10.1023/B:JOHE.0000038655.19448.b2

4. Monroe, A., Ricketts, T., & Savitz, L. (1992). Cancer in rural versus Urban Populations: A review - monroe - 1992 ...Wiley Online Library. Retrieved September 18, 2022, from https://onlinelibrary.wiley.com/doi/10.1111/j.1748-0361.1992.tb00354.x

5. O'Connor, A., & Wellenius, G. (2012, August 24). Rural–urban disparities in the prevalence of diabetes and coronary heart disease. Public Health. Retrieved September 18, 2022, from https://www.sciencedirect.com/science/article/pii/S0033350612002016

6. Mozaffarian, D., Wilson, P. W. F., & Kannel, W. B. (2008, June 10). Beyond established and novel risk factors. Beyond Established and Novel Risk Factors: Lifestyle Risk Factors for Cardiovascular Disease . Retrieved November 9, 2022, from https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.107.738732

7. Pearson-Stuttard, J., Bandosz, P., Rehm, C. D., Penalvo, J., Whitsel, L., Gaziano, T., Conrad, Z., Wilde, P., Micha, R., Lloyd-Williams, F., Capewell, S., Mozaffarian, D., & O’Flaherty, M. (2017). Reducing US cardiovascular disease burden and disparities through national and targeted dietary policies: A modelling study. PLOS Medicine. Retrieved November 9, 2022, from https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1002311

8. Pollock, E. A., Givens, M. L., & Johnson, S. P. (2022, March 9). Voting and civic engagement rights are eroding: What does it mean for Health and equity? Health Affairs Forefront. Retrieved November 10, 2022, from https://www.healthaffairs.org/do/10.1377/forefront.20220307.730059/


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