Factors that can lead to cardiovascular diseases and heart failure have been the focus of many studies. Tobacco use, diabetes and lack of physical exercise are among the common risk factors that are often associated with cardiovascular disease.

However, research has shown that there are also considerable geographic factors that could influence heart disease and cardiovascular-related mortality patterns.

Wealth of country could affect prognosis of heart failure patients

Thomas Callender from The George Institute of Global Health and several other authors found that patients with heart failure had a poorer immediate prognosis across low- and middle-income countries (LMICs), as compared to those in high-income countries. Embase, Medline, Global Health Database and World Health Organisation regional databases were searched for studies from LMICs published between 1995 and 2014. Unpublished data were also requested from investigators and international heart failure experts for this study.

In-hospital mortality rates were also higher in LMICs – 8.3% compared to 6.7% in the EuroHeart Failure II Survey and 4% in ADHERE in the US. The study points out the necessity of having better strategies for heart failure surveillance and management in such countries.

Geographical location influences heart failure rates

The difference in the rates of cardiac events between residents living in different geographical locations was also analysed in a study. 5.5 million adults aged between 40 and 79 residing within 14 Local Health Integration Networks in Ontario, Canada were involved in the study. The authors found a striking variation in the rates of heart attack, stroke or cardiovascular-related death depending on where a person lived. 

The regions with the lowest number of cardiovascular events had more frequent doctor visits, were more likely to be screened for heart disease risk factors and had better control of high blood pressure compared with those who lived in areas with higher number of events. On the other hand, residents living in regions with the highest event rates were more likely to be obese, to smoke and to have the lowest dietary fruits and vegetables intake.

Climate may increase risk of cardiovascular diseases and mortality

The link between cardiovascular diseases and geographic variations also brings to light how differences in climate and temperature can contribute towards cardiovascular diseases and mortality. Yu-Kai Lin together with other researchers found that low temperature was associated with greater risk of cause-specific mortality from cardiovascular diseases.

Additionally, it was found that the mortality risk from cardiovascular diseases was significantly associated with extreme heat events lasting for more than five days. However, the risks were varied, depending on the location of the study and the causes of mortality. The lowest mortality was associated with an average temperature of 27 degrees Celcius. The study was conducted from 1994 to 2007 in Taiwan.

The link between pollution and risk of heart disease

The level of exposure to pollution and noise experienced by individuals is yet another interesting finding that could explain the increase in risks of heart disease. In a study based on the data from the Hypertension and Environmental Noise near Airports (HYENA) study, researchers examined this association among residents exposed to different levels of aircraft noise and road traffic noise across major airports throughout Europe. The data was collected between 2004 and 2006.

Results showed a statistically significant association between exposure to night-time aircraft noise and heart disease as well as stroke in individuals who had resided in the same home for 20 years or more. In addition, an association was also found between exposure to 24-hour road traffic noise and heart disease, although this was confounded by exposure to nitrogen dioxide pollution.

In a nutshell, findings that point to this significant cardiovascular-related mortality pattern should provide better understanding of the relevant factors that come into play within certain geographical regions and locations. Hence, in this matter, the quality of healthcare delivery system, climate change, health literacy and awareness are all aspects that might warrant further analysis. MIMS

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857249/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015897/