Reducing premature death from heart disease requires a broad approach

February is American Heart month. This acknowledges heart disease as the No. 1 cause of death in the United States, in spite of the incredible amount of resources put toward lessening its impact. Heart disease claims as many lives each year as cancer, lower respiratory diseases and accidents combined, and the treatment of cardiovascular disease accounts for one in every six health care dollars spent.

The American Heart Association continues to encourage people to lower their risk by quitting smoking, losing weight, exercising regularly and eating healthy. Although these simple lifestyle recommendations sound straightforward and easy to accomplish, the reality is otherwise. Americans continue to have sedentary lifestyles and eat imbalanced diets high in saturated fats, sugars and salt, which together are making us fatter and setting us up for heart disease and other health problems. Vaping, once thought to be a safer alternative to smoking cigarettes, has recently been found to increase the risk for heart disease, heart attacks and strokes.

The AHA also encourages Americans to know their cholesterol and blood pressure measurements, since these are critical risk factors for heart disease, as well as stroke. One-third of Americans have elevated cholesterol levels, and almost half of adults have high blood pressure. Even small changes in blood pressure can be important. For example, a very small increase in systolic blood pressure (2 mm Hg) raises the risk of death from heart disease by 7% and the risk of death from stroke by 10%.

While Washington state’s overall rate of heart disease is lower than the national average, large disparities exist that are a cause for concern. These have recently made local news, as our research found stark gaps in life expectancies among different social groups in the state. By studying the nearly quarter of a million deaths in Washington state between 2011 and 2015, we found the chances of dying prematurely (before age 65) from heart disease were 1.6 times greater for state residents from poorer communities compared to people from more affluent areas. More striking, premature deaths from heart disease among some racial minorities in the state were much more common than among whites. For example, premature death was more than twice as common among blacks and Native Americans or Alaska Natives, compared to whites.

What might explain these disparities? Access to health care plays a part, since having regular checkups can help identify risk factors and provide opportunities for preventive efforts before heart disease takes hold. In a separate study, we also found deaths from heart disease were higher in areas with few primary care physicians. For example, communities with the highest rates of heart disease deaths were three times more likely to lack a local primary care physician, compared to communities with the fewest deaths. But health inequities are also caused by sociopolitical and environmental conditions where people live and work. These may include poor housing, poor air quality, lack of access to social services and community design that makes walking and biking difficult or unsafe. For racial minorities, the experience of discrimination and racism has profound, negative impacts on health, including the risk of heart disease. Importantly, the impact of adverse life experiences, often beginning in childhood and existing along life’s continuum, creates a state of chronic stress shown to increase rates of heart disease as well as other chronic conditions.

What can be done? Public health professionals and health care systems are recognizing the importance of going beyond the narrow focus of medical and behavioral interventions on individuals, to whole-systems approaches of population health. Health care is part of this, especially increasing access for communities and populations around the state that have historically lacked adequate medical care. A founding purpose of WSU’s Elson S. Floyd College of Medicine is to improve health care access in rural and underserved communities across the state, by training students from these communities and through a community-based medical curriculum that is tailored to build knowledge and skills for new physicians to address the unique challenges and needs of their communities.

Locally, the Spokane Regional Health District leads community-focused efforts to make healthy choices the easy choices. City, county and federal initiatives to improve housing opportunities, increase access to green spaces, build more walkable communities and encourage nonmotorized transportation represent environmental approaches that can enable healthy living. But the greatest impact will come when our community collectively addresses the conditions that create societal stratification, such as financial insecurity, low educational attainment, gender and racial discrimination and other adverse life experiences. We are healthier when we care as much for one another as we do for ourselves.