Environmental and societal influences

Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review

Clara Kayei Chow^1,*, Karen Lock², Koon Teo¹, SV Subramanian³, Martin McKee² and Salim Yusuf¹

¹ Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
² LSHTM, Keppel Street, London WC1E 7HT, UK.
³ Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.

* Corresponding author: Dr Clara Kayei Chow, Senior Research Fellow, Population Health Research Institute, Hamilton General Hospital, 237, Barton Street East, Hamilton, ON L8L 2X2, Canada. E-mail: clara@phri.ca

	Abstract

It has long been known that cardiovascular disease (CVD) rates vary considerably among populations, across space and through time. It is now apparent that most of the attributable risk for myocardial infarction ‘within’ populations from across the world can be ascribed to the varying levels of a limited number of risk factors among individuals in a population. Individual risk factors (e.g. blood pressure) can be modified with resulting health gains. Yet, the persistence of large international variations in cardiovascular risk factors and resulting CVDincidence and mortality indicates that there are additional factors that apply to ‘populations’ that are important to understand as part of a comprehensive approach to CVD control. This article reviews the evidence on why certain populations are more at risk than others./.../