Keeping a healthy heart may have as much to do with the quality of health care you have available as it does avoiding risk factors such as smoking, bad diet and little exercise.
A large international study led by researchers at the Population Health Research Institute at McMaster University and Hamilton Health Sciences has found that low-income countries which have people with the lowest risk factors for cardiovascular problems have the highest rates of cardiovascular events and death, while the high-income countries of people with the highest risk factors for heart conditions have a lower rate of severe heart problems and deaths.
The paper, published in the New England Journal of Medicine, involved more than 156,000 people in 17 countries world-wide who took part in the Prospective Urban Rural Epidemiologic (PURE) Study.
"There is a real paradox. We have found that richer countries with higher risk factors have less heart disease and once people have a heart attack or stroke, the risk of dying is substantially less compared to poor countries," said Dr Salim Yusuf, principal investigator for the study.
But 80 percent of the deaths each year from cardiovascular disease happen in low and middle income countries. Yusuf said the difference is the quality of health care. "We have found that health care is as important, if not more important, than avoiding the risk factors in reducing cardiovascular disease."
Yusuf added that for better heart health, "the rich countries should continue to deliver high quality health care while trying to reduce risk factors, while poor countries need to avoid the rise of risk factors but also substantially improve their health care."
Risk factors for cardiovascular problems include smoking, high cholesterol, high blood pressure, diabetes, obesity, stress and not enough fruits and vegetables or exercise.
Participants were from both urban and rural areas of four low-income countries of Bangladesh, India, Pakistan or Zimbabwe; 10 middle-income countries of Argentina, Brazil, Chile, China, Colombia, Iran, Malaysia, Poland, South Africa and Turkey; and from three high-income countries of Canada, Sweden and the United Arab Emirates.
Population Health Research Institute, New England Journal of Medicine, US, Hamilton Health Sciences