Studies from the American Heart Association suggest that up to 80% of cardiovascular disease cases are preventable. However, CDC records show that cardiovascular disease is still the leading cause of death in the U.S. for men and women of most racial and ethnic groups.
If a better diet, blood pressure, cholesterol, and an active lifestyle—coupled with regular screenings—can help prevent the conditions, why are the rates still so high?
The answer, of course, is nuanced.
This Heart Health Month, Wellth is breaking down why heart-related mortality rates are still so high, and what healthcare systems can do to catch and address problems early-on.
It’s becoming widely accepted that social determinants strongly impact an individual’s risk for developing certain chronic conditions. For heart-related conditions, such as hypertension or cardiovascular disease, these disparities are even more pronounced.
Because heart conditions are often avoidable, lifestyle plays a key role in prevention. However, in low-income communities, many individuals and families frequently lack access to fresh or healthy foods, and instead must rely heavily on diets of cheap calories.
Not only do these highly-processed diets contain high amounts of saturated fats, salts, and sugars that contribute to conditions like obesity and hypertension, but they leave the individual without key nutrients needed for long-term health. In addition to the health challenges caused by food insecurity, studies have shown that the everyday stressors faced by populations with the lowest socioeconomic status create additional risks for cardiovascular diseases.
For example, in a study of income and health disparities led by Harvard Medical School, individuals living in low-income neighborhoods had roughly 4xs the risk of major cardiac events compared to individuals living in high-income neighborhoods—even when adjusting for smoking, obesity, access to health insurance and other key risk factors for cardiovascular disease.
For healthcare systems, reducing the economic stressors that contribute to poor diet or living conditions is key to addressing the national prevalence of cardiovascular disease and improving overall heart health. Even small acts, like flexible rewards that prevent members from having to choose between feeding a family and paying for their type 2 diabetes medication or transportation to work, can go along way in both addressing the social determinants themselves and the stress that those disparities cause in the lives of individuals and communities.
Socioeconomic status is not the only determinant of proper health. Additional factors, including race, strongly impact heart health outcomes due to the disparities in healthcare faced by vulnerable populations.
According to a 2021 five year study measuring the difference in health outcomes between Black and Non-Black patients, Black patients were 84% more likely than other Non-Black patients to encounter a cardiovascular event within the five years. Of this difference, researchers found that 46% of the difference could be attributed to risk factors stemming from low socioeconomic status. However, the remaining 54% was a result of psychological and clinical disparities as a result of race.
Composite and Individual Outcomes by Race
Additional studies also show many other minority races face healthcare disparities within the U.S. in other areas as well.
With February also being Black History Month, it’s worth taking a look at practices within the healthcare system to determine what can be done at an organizational level to support diverse communities. From hiring clinical staff that reflect the communities they serve, to collecting, analyzing, and acting on data showcasing member race, ethnicity and health, there are steps organizations can take to reduce gaps in care faced by minority populations.
Even when social determinants and health inequities have been addressed, there will still be people who struggle to make the lifestyle changes necessary to avoid cardiovascular diseases.
Behavioral economics proves that people need more than just education to make the right choice. They need motivation.
Studies have shown that just 10% of patient outcomes are determined by medical care. The other 90% come down to genetics (30%), social and physical environment (20%), and 40% of health outcomes are determined by individual behavior. In other words, without the right motivation to change daily behaviors—like diet, exercise, and proper condition management—long-term disease progression is unlikely to change.
Conversely, the right small changes in daily life can significantly impact long-term heart health. It’s more important than ever for health plans and providers to actively support individuals in forming healthy habits now, and behavior change programs like Wellth are helping.
Wellth builds motivation for healthy habits in its members through carefully structured incentive programs—encouraging them to eat right, exercise, take glucose readings, obtain important preventative care, and more for a financial reward. But more often than not, the rewards of healthy living go beyond the incentives and include better health, confidence, and quality of life.
Wellth works regularly with members to promote heart health—including regular blood pressure checks, adherence to prescribed aspirin and heart medications regimens, and more. As a result, readmissions, utilization, and quality of life improve.
For many Wellth members battling congestive heart failure, cardiovascular disease, or other heart health conditions, simply remembering to take medications or adhere to care plans as prescribed not only alleviates symptoms associated with their condition, but sparks other healthy changes leading to better quality of life. As one member with CHF shares:
"Wellth itself is amazing. I’m not as tired, I don’t feel run down, I can walk that little extra distance. This program can reach anybody, and if they have a bad heart condition like I have, this would help them a whole lot."
While cardiovascular disease may be the current leading form of deaths in the U.S., it doesn’t have to be. By understanding the factors that contribute to high heart health risk, and addressing them at the organizational, systemic, and individual level, we’re better prepared to support these members for healthier todays, and tomorrows.