The Road Towards a Heart-Healthy Future
WHO Collaborating Centre for Public Health Education and Training, Imperial College London
"Health is a state of physical, mental, and social well-being and not merely the absence of disease or infirmity."
February was HeartMonth, which got us at the WHOCC for Public Health Education & Training thinking about the global burden of cardiovascular disease (CVD), one of the leading causes of mortality worldwide.
What is CVD?
CVD refers to a class of disorders that affect the heart and blood vessels. It is a broad term[1] which, according to the World Health Organization (WHO) and NHS (National Health Service, UK), encompasses various conditions, including:
With the exception of Africa, CVD is a leading cause of morbidity and mortality worldwide, affecting mostly the male population[2]. According to the WHO, an estimated 17.9 million deaths occur annually due to CVD. CVD certainly poses a significant global health challenge, with regions such as the Eastern Mediterranean region (EMR) expected to experience a particularly pronounced surge in CVD cases.
CVD and prevention
Many cases of CVD can be prevented through lifestyle changes and early detection.
Key strategies include:
Consulting healthcare professionals for a personalised prevention plan, regular monitoring, and lifestyle adjustments form a comprehensive strategy for preventing CVD. Fighting CVD requires a joint effort between individuals, communities, and healthcare systems, which will be even more so important in the future.
The road towards Universal Health Coverage (UHC)
On a global scale, addressing cardiovascular disease is vital for achieving Universal Health Coverage (UHC) and the United Nations Sustainable Development Goals (SDGs). UHC would ensure that everyone, without financial strain, receives comprehensive and affordable cardiovascular care, spanning prevention to rehabilitation; including medications, diagnostics, and surgeries. UHC promotes prevention through health education, early detection, and timely intervention; easing the economic burden and ensuring equitable access. The SDGs, especially SDG3 on health and well-being, directly relate to cardiovascular disease. Target 3.4 aims to reduce premature mortality from non-communicable diseases (NCDs), including CVD, by one-third. Other SDGs, like SDG 1, SDG 2, and SDG 10 also have a significant impact on CVD. This emphasizes that addressing things like poverty, malnutrition, and social inequalities will not only help in achieving the SDGs but also reduce the burden of CVD. To combat cardiovascular disease effectively, a holistic approach is essential. Strengthening healthcare systems, addressing social determinants of health, promoting healthier lifestyles, and ensuring financial protection form an interconnected strategy. Integration of cardiovascular health into UHC and SDGs includes prevention, early detection, and management strategies, facilitated by public health campaigns, education, and community engagement. By incorporating cardiovascular health into UHC strategies, we will be prioritising global initiatives that promote healthier populations, tackle current health challenges, and strengthen resilience against potential future health crises.
The importance of primary healthcare
Furthermore, investing in primary healthcare is a cornerstone in the battle against cardiovascular diseases. By strengthening primary healthcare systems, we can enhance early detection, provide essential education on prevention, and ensure timely management of risk factors. Data shows that for every $1 invested in primary healthcare, there is a significant return in terms of improved health outcomes and cost savings[10]. Countries with robust primary healthcare infrastructures report lower rates of CVD-related hospitalisations and better overall community health. This underscores the long-term benefits and cost-effectiveness of channelling resources into preventive and primary healthcare measures.
Climate Change and its Effects on CVD and Heart Medications
Climate change, with extreme temperatures, also exacerbates the risk of CVD. It has been established that such extreme climatic episodes—both hot and cold, set to become more frequent over the coming years — are linked with increased mortality from CVD[11]. The duration and intensity of exposure, along with the resilience of local populations and infrastructure, are the main factors determining the outcome of such events. Heat impacts the body's ability to control temperature, putting stress on the respiratory and cardiovascular systems[12]. With warmer temperatures, the body sends more blood to its outer parts, causing the heart rate to rise. Dehydration, worsened by heat, also increases the risk factors for cardiovascular disease. On the flip side, cold temperatures decrease blood flow by narrowing blood vessels, making the cardiovascular system work harder and demanding more effort from the heart. Vulnerable populations, such as children, the elderly, and those living in poverty, are particularly susceptible to the adverse effects of extreme temperatures.
Furthermore, as global temperatures rise due to climate change, heat can significantly impact the effectiveness and stability of heart medications. High temperatures can accelerate the degradation of pharmaceutical compounds, potentially altering the potency and dosage consistency of these medications[13]. Moreover, heat exposure may compromise the integrity of medication storage conditions, leading to reduced efficacy and potential health risks for individuals relying on these drugs to manage cardiovascular conditions[14]. Thus, as temperatures continue to increase, it becomes increasingly critical to monitor and mitigate the impact of heat on the quality and effectiveness of heart medications to ensure optimal patient care and outcomes.
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The socioeconomic and environmental determinants of CVD
The environment also significantly influences the impact of heat. With cities experiencing more frequent “urban heat island” phenomena due to conventional urban design ampliying heat, populations are at high risk of suffering from CVD[15]. Furthermore, the built quality of homes also affects the effect of extreme temperatures. Households with poor insulation and low energy efficiency are indeed more prone to suffering from such events. In addition, air pollution has been found to have a synergistic negative effect with heat. Poor air quality can trigger inflammation, thereby negatively affecting the cardiovascular system.
Communities of lower socioeconomic status (SES) present substantially more risk factors for CVD compared to wealthier communities, making SES one of the most important factors contributing to CVD. Financially disadvantaged populations indeed face more barriers towards adopting healthy lifestyles due to lower education, limited access to exercise-friendly environments, low income, and difficulties accessing healthcare services, essential for diagnosing and treating CVD and its risk factors. Moreover, individuals of lower SES often reside in precarious housing conditions and are exposed to higher environmental hazards such as air pollution, which as mentioned above further exacerbates the risk of CVD.
How our research contributes to the fight against CVD
Our WHO Collaborating Centre is currently investigating the impacts and trends of CVD in the country of Iraq. CVD remains the leading cause of mortality within the Iraqi population, and our findings show that it is on the rise, with ischemic heart disease and stroke being the most found types of CVD in the region. The Iraqi population is substantially exposed to risk factors such as high blood pressure, diabetes, smoking, pollution, and heat; which could explain the steady rise in CVD patients. As countries in the Eastern Mediterranean region will increasingly grapple with heatwaves in the coming years, it is vital to strengthen primary healthcare systems. It is essential to promote healthy lifestyles, in addition to preventative medicine including regular primary care visits and raising awareness. What is more, addressing climate change and its detrimental impact are imperative steps towards reducing the toll of CVD both in Iraq and globally. Further proactive policy-based interventions such as implementing tobacco control measures and addressing the socioeconomic disparities and environmental determinants would pave the way towards healthier communities and a more resilient future.
Heart Month is a much-needed reminder for us to maintain our efforts towards reducing the global burden of CVD, and emphasise the interconnectedness of health, environment, and social equity. Committing to fighting CVD will benefit several other sectors beyond the immediately affected people — time to ramp up our efforts.
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Public Health Education & Research Content Co-ordinator / Sociology Student
8moWell done Philippe Weissenberg Anaboli & Ryan Mak for writing such an informative article on a disease that detrimentally impacts so many people's lives globally 👏 👏 👏