Cardiovascular diseases in adults over 20 years old in Paterson NJ
Introduction: Cardiovascular diseases are the leading cause of death in adults worldwide. The WHO (2022) estimates the deaths at 17.9 million annually. Cardiovascular diseases (CDVs) are disorders affecting the heart and blood vessels. They include cerebrovascular accident(CVA), coronary heart disease, and rheumatic heart disease. A third of cardiovascular deaths occur in people less than 70 years old, and more than four out of five deaths are due to CVAs and heart attacks (WHO,2022).
The high rates of premature mortalities due to CVDs necessitate formulating an effective action plan to curb the menace. Also, this could preserve a healthy, productive population to steer the country’s economic development efforts. CVDs affect people as young as 20 years old, the prime age for economic, sexual, and physical productivity. Since it is preventable, employing the preventive strategies from earlier on in life is critical to maintaining a healthy lifestyle and living a quality life even in late adulthood. This essay intends to discuss the risk factors, epidemiology, strategies to address this health issue, and policy action to support those strategies.
CVDs are associated with several behavioral risk factors. Stress and physical inactivity increases the risk for CVDs. However, regular, moderate to intense physical activity minimizes the risk of CVDs by controlling the blood cholesterol levels, being overweight, blood pressure, and blood glucose levels (WHO, 2022). Second, excessive alcohol intake predisposes one to CVDs by raising blood pressure and triglyceride levels and causing cardiac arrhythmias (CDC, 2022). Excessive intake is associated with obesity, suicide, and accidents. Therefore, moderate alcohol consumption is more beneficial (CDC, 2022). Third, increased use of tobacco predisposes one to CVDs compared to nonsmokers. Fourth, an unhealthy diet that has a negative impact on the controllable risk factors, such as cholesterol, obesity, and blood pressure, increases the risk of CVDs (CDC, 2022). Lastly, diabetes is also a significant risk factor for CVDs. In diabetes, the body either does not make enough insulin or the insulin receptors are resistant to insulin. As a result, insulin accumulates in the blood leading to adverse health problems, including heart disease, renal failure, and vision loss.
CVDs are a silent killer, with most of their features progressing gradually while the individual remains asymptomatic. This aspect makes it fatal since early detection is crucial to effective treatment and recovery. Nevertheless, living a healthy lifestyle remains the key strategy to reducing the incidence rates of CVDs. Failure to address CVDs risk factors at the primary healthcare level leads to preventable premature deaths through strategic public health interventions. Creating health policies that provide conducive environments for individuals to make affordable and available healthy choices is crucial to motivating individuals to adopt and maintain a healthy lifestyle.
According to the CDC (2022), CVDs are among the leading causes of death globally and the leading cause in the United States. The CDC (2022) statistics state that CVDs account for one death every 36 seconds in the U.S. approximately 659,000 people die from CVDs annually in the U.S. coronary artery disease is the most common CVD accounting for 18.2 million cases (6.7%) in adults older than 20 years. Every year, approximately 805,000 people in the U.S. experience a heart attack.
High poverty rates are associated with an increased risk of several diseases, including CVDs, diabetes, and cancer. According to Tawakol et al. (2019), these risks are driven by limited access to healthcare services at the primary level. The study associates high rates of tobacco use with people with lower incomes. Also, the high-stress levels associated with lower-income households are linked to chronic inflammation that plays a role in the developing CVDs (Tawakol et al., 2019). The study established increased activity in the amygdala and high inflammation in the arteries of those who had high-stress levels. These groups of people were at a high risk of experiencing cardiovascular events such as stroke and heart attack in the following years (Tawakol et al., 2019).
According to the United States Census Bureau (2019), the national poverty rate in the U.S. is 13.4%, and that of Paterson, NJ, was 26.6% which is higher than the national rate. Adequate evidence shows a positive correlation between high poverty rates and increased risk of cardiovascular diseases. The high risks are attributed to increased stress levels, tobacco use, excessive alcohol intake, and consumption of an unhealthy diet.
A study by Manemann et al. (2021) outlines the trends in CVD over the years. While CVD mortality rates by age and sex decreased by 3.7% annually from 2000 to 2009, there has been no observable change from 2010 to 2018. The study documents an increase in deaths from CVDs other than coronary heart disease between 2010 and 2018, particularly among the elderly (65 to 84 years old). These trends underscore the urgent need to address CVDs through preventive and treatment intervention strategies.
Strategies to address CVDs in Paterson, NJ
As a significantly growing health concern, addressing CVDs through evidence-based public health strategies is crucial. The first strategy is to implement tobacco prevention and control strategies. Despite the low rate f cigarette smoking in developed countries, the global sales of cigarettes keep increasing due to increased consumption in developing nations. Addressing tobacco use requires short and long-term strategies. A short-term strategy is to help current tobacco users quit smoking. A long-term strategy is to prevent the initiation of tobacco use by adolescents and young adults. The MPOWER tobacco control strategy recommended by the WHO addresses both approaches through monitoring the use of tobacco and prevention policies, protecting people from tobacco use, offering to help quit smoking, warning about the dangers of tobacco, enforcing bans on advertising, promoting, and sponsoring tobacco, and increasing tobacco taxes (Schwalm et al., 2016). Even though the taxes on tobacco were raised in N.J. by $2.70 to discourage tobacco purchase, there’s a need to enforce laws that control tobacco marketing.
The second strategy is enforcing dietary policies to ensure healthy foods’ affordability, availability, and marketing. Increased fruit and vegetables, reduced saturated fats, and eradicating trans fats in the diet are linked to a lower risk of CVDs (Schwalm et al., 2016; WHO, 2022). However, healthy foods (fruits and vegetables) are more expensive than unhealthy ones. Also, this is associated with the high agricultural subsidies for food products like high fructose corn syrup in developed countries. Therefore, implementing policies that ensure poor households have access to nutritious food at an affordable price is key to reducing the prevalence of CVDs in Paterson, NJ.
The third strategy is implementing cardiovascular disease risk screening and management procedures at the primary healthcare level. While the current diagnostic and management procedures for CVDs are pretty expensive, simple, cost-effective interventions are needed to address the modifiable risk factors such as increased blood pressure, tobacco use, and secondary prevention common in populations under 35 years old. Most guidelines for detecting and managing hypertension recommend initiating treatment following multiple elevated blood pressure readings (Schwalm et al., 2016). These are among the recommendations that prevent the early initiation of effective interventions. According to the PURE study, roughly 90% of people with an initial systolic blood pressure of more than 160mmHg, had sustained high blood pressure readings on subsequent visits within one year, meeting the criteria for hypertension diagnosis (Schwalm et al., 2016). The simplified screening process of initiating hypertension treatment following an initial high blood pressure reading of more than 160 mmHg is one of the strategies to address CVDs through timely interventions.
Lastly, resource-efficient management of acute clinical manifestations of CVD is key to reducing morbidity and mortality rates. For instance, the WHO recommends using aspirin and streptokinase for acute management of ST-segment-elevation myocardial infarction, which is cost-effective (Schwalm et al., 2016). Additionally, the WHO considers clopidogrel, ACE inhibitors, beta-blockers, statins, and diuretics essential medications in managing stroke, acute heart failure, and acute coronary syndrome. Ensuring the availability of these medications affordably through the elimination of copayments leads to improved compliance with treatment regimens and CVDs risks without increasing healthcare costs.
The government needs to strengthen public health institutions by developing and maintaining sufficient capacities and competencies to screen for CVDs risks and manage them. Public health institutions at local levels must launch cardiovascular health prevention and promotion programs. Mass health promotion through behavioral change and prevention of the associated risk factors require skills and resources. Also, public health institutions must learn to manage and utilize health data systems to monitor and assess interventions and prevention programs effectively. Lastly, in collaboration with public health agencies, the national and local governments must maintain the laboratory capacities and standards to address the increasing CVD screening demands and research opportunities.
In collaboration with the local public health agencies, the state government needs to employ comprehensive public health strategies to reduce the prevalence of CVDs by promoting CV health interventions in diverse settings for all people regardless of their age, particularly in high-risk groups. This strategy involves promoting desirable social and environmental conditions and favorable behavioral patterns to avert significant risk factors. It also involves assurance of accessibility of quality health services and their timely use among the high-risk population. For instance, besides using mass media for health promotion in all age groups, public health institutions can partner with the communications sector to relay automatic health promotion messages to people living in Paterson, NJ. Also, the state government must channel resources for research and training of more individuals in primary health care agencies for timely provision of quality health services.
Prevention of CVDs requires immediate actions from various stakeholders. Initiating and sustaining the above policy actions need commitment from the national, state, and local public health institutions. Implementation of this action plan complements guidelines from global health organizations and the HealthyPeople 2030 goal for CVD prevention.
Centers for disease control and prevention (CDC). (2022). Heart Disease Facs. Retrieved from https://www.cdc.gov/heartdisease/facts.htm#:~:text=Heart%20disease%20is%20the%20leading,groups%20in%20the%20United%20States.&text=One%20person%20dies%20every%2036,United%20States%20from%20cardiovascular%20disease.&text=About%20659%2C000%20people%20in%20the,1%20in%20every%204%20deaths.
Manemann, S. M., Gerber, Y., Bielinski, S. J., Chamberlain, A. M., Margolis, K. L., Weston, S. A., … & Roger, V. L. (2021). Recent trends in cardiovascular disease deaths: a state specific perspective. BMC Public Health, 21(1), 1-7.
Schwalm, J. D., McKee, M., Huffman, M. D., & Yusuf, S. (2016). Resource effective strategies to prevent and treat cardiovascular disease. Circulation, 133(8), 742-755.
Tawakol, A., Osborne, M. T., Wang, Y., Hammed, B., Tung, B., Patrich, T., … & Armstrong, K. A. (2019). Stress-associated neurobiological pathway linking socioeconomic disparities to cardiovascular disease. Journal of the American College of Cardiology, 73(25), 3243-3255.
United States Census Bureau. (2019). Poverty status in the past 12 months. Retrieved from https://data.census.gov/cedsci/table?q=&t=Poverty&g=0100000US&tid=ACSST5Y2019.S1701
World health organization (WHO). (2022). Cardiovascular Diseases. https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_3
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