BURNABY, B.C. — A top cardiovascular researcher at Simon Fraser University is warning that standard heart health advice—like exercising regularly and eating more vegetables—may not work for much of the world’s population.
Dr. Scott Lear, a health sciences professor at SFU and Chair in Cardiovascular Prevention Research funded by Pfizer and the Heart & Stroke Foundation, says global guidelines for preventing cardiovascular disease (CVD) often ignore the realities of low- and middle-income countries, where 80 per cent of CVD-related deaths occur.
“Advice like getting 75 minutes of exercise per week or eating five servings of fruit and vegetables a day doesn’t apply equally around the world,” said Lear. “Life in Vancouver’s West End is very different from life in New Delhi, where people walk out of necessity, not choice, and face severe air pollution and limited public transit.”
Lear is the lead author of a new review that looks at social, environmental, and policy factors that influence CVD. The paper draws on data from the Prospective Urban Rural Epidemiology (PURE) study, a global health project that began in 2002 and now includes more than 212,000 participants across 28 countries.
The study collects data every three years, including surveys, physical health measurements, and targeted questionnaires related to cardiovascular disease.
Lear’s review found that health risks like poor nutrition, air pollution, social isolation, lack of healthcare, and limited access to medications are major contributors to heart disease around the world—often more than personal behavior.
Exercise and Class Divide
While lack of physical activity is a known risk factor for heart disease, the review found a difference in how activity is done. In high-income countries, people often get exercise during their free time. In contrast, physical activity in low-income countries usually comes from work, household chores, or travel.
Surprisingly, self-reported exercise levels were highest in wealthy countries—even though over 22 per cent of people there sit for more than eight hours a day. In poorer countries, only 4.4 per cent reported sitting that long, but their overall activity levels were still lower.
Healthy Food Remains Out of Reach
A diet rich in fruits, vegetables, legumes, fish, dairy, and nuts helps reduce the risk of heart disease. The review found that such foods are easier to find and more affordable in cities, regardless of a country’s income level. However, fruit and vegetable intake remains low in poorer countries.
“Many small-scale farmers can’t even afford to eat the food they grow,” said Lear.
Next Steps
Lear says the findings highlight the need for heart health strategies that reflect local conditions, not just global averages. He calls for a broader approach that includes improving access to nutritious food, clean air, and affordable healthcare.
“Cardiovascular disease isn’t just about personal choices—it’s about the world we live in,” Lear said.
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