Prepare to scratch your head in confusion as we consider the subject of geography for a moment.
In the U.K., the Brits’ high daily consumption of saturated and trans fats – chief suspects among risk factors for heart disease - is actually topped by those living in Germany, Belgium and France. Yet these three salami-eating countries boast fewer heart disease deaths than the U.K., according to the British Heart Foundation.
Even more confusing are the people of France. Although the French smoke more, eat more fat, and consume only slightly more fruit and vegetables than the British do, the French have the lowest heart death rate in the European Union – only about one-quarter of the British rate. This is the notorious “French Paradox“, which epidemiologists have puzzled over for decades.
Although French hearts appear to be the healthiest and best preserved in Europe, they are certainly among the worst on the risk factors of diet and smoking.
The Spaniards, Finns, Italians, and Portuguese all eat less harmful fat and consume more fruit and vegetables than the French – yet die in greater numbers from heart disease.
How can this be?
According to the United Nations, in their report called UN Chronicle: The Atlas of Heart Disease & Stroke, Japan has one of the lowest rates of coronary heart disease in the world, but the Japanese were found to have a gradually increasing risk after moving to North America, eventually approaching that of those people born there. This sounds to me that lifestyle changes resulting from this move (↓ diet, ↓ exercise, ↑ stress) must have some influence on heart disease rates.
But why don’t the same heart disease risk factors seem to affect those Gauloises-smoking, double-cream brie and baguette-eating French?
Meanwhile, the highest rate of heart disease on the planet fluctuates a bit from year to year, but the annual winners seem to rotate around Eastern European populations in Ukraine, Bulgaria, Russia and Latvia.
Those Ukrainians, with a whopping 891 heart attacks per 100,000 population, are hard to beat on dietary risk factors alone. I grew up here in a Ukrainian family, where our basic food groups were sour cream, bacon and butter. We considered dill pickles to be a vegetable dish in our house. And yet my own Baba lived well into her 90s, outlived three husbands, and was doing her own gardening and canning until almost the very end of her life. In that respect, she was behaving more like a French woman!
Researchers at Harvard University’s School of Public Health have come up with one theory about these confusing heart attack rates in their report called The Nutrition Source: Low-Fat Diet Not A Cure-All.
Here in Canada, when it comes to our likelihood of suffering a heart attack, the geography of our country also plays a role – along with our income.
New data from the Canadian Institute for Health Information show that the rate of heart attacks in Canada’s lowest-income neighborhoods was 255 per 100,000 population, compared to 186 per 100,000 in the most affluent ones. That’s a significant 37% difference.
The CIHI report released in May, called Health Indicators 2010, shows that heart attack rates here are actually doubled between some provinces, ranging from just 169 per 100,000 population here on the Pacific coast in British Columbia, to 347 per 100,000 far away on Canada’s Atlantic coast in Newfoundland and Labrador.
Dr. Indra Pulcins, director of indicators and performance measurement at CIHI, explains:
“Important gaps in heart health still exist between socio-economic groups, as well as between geographic regions in Canada. There are a lot of factors that come into play. But one thing we do know is that where there is variation, there is potential for improvement.”
The average age of heart attack sufferers in Canada is 71. Just over 35% of heart patients here are women, yet our outcomes are worse than male heart patients. Over half of all heart attack deaths occur in women.
The most surprising evidence from CIHI suggests that where you live has the most significant impact on heart attack rates, followed by neighbourhood income; these factors were more impactful than cardiac risk factors cited traditionally – like diet and exercise.
The good news, according to the report, is that regardless of a person’s income or place of residence, both the care they received and their treatment outcomes were similar no matter where in Canada they lived.
Q: How critical are lifestyle choices to heart health?
♥ This article was #3 on the Top 10 Most-Read Posts here on Heart Sisters for 2013.
♥ See this ranked list of coronary heart disease death rate by country determined by WHO, World Bank, UNESCO, CIA and individual country databases for global health and causes of death (2011).