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IJE Advance Access published online on March 4, 2009
International Journal of Epidemiology, doi:10.1093/ije/dyn258
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2009; all rights reserved.

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

Clara Kayei Chow1,*, Karen Lock2, Koon Teo1, SV Subramanian3, Martin McKee2 and Salim Yusuf1

1Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
2LSHTM, Keppel Street, London WC1E 7HT, UK.
3Department 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{at}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 CVD incidence 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.

Keywords Population health, environments, societal determinants, cardiovascular risk factors

Accepted 28 October 2008


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