Fewer than one in 10 Canadians in ideal cardiovascular health

Cardiovascular disease, which includes heart disease and stroke, is the second leading cause of death in Canada.

"A large proportion of Canadians are in poor cardiovascular health, and the overall trend has not changed in the past decade," says senior author Dr. Jack Tu, from the Institute for Clinical Evaluative Sciences (ICES) and the Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario. "There is an urgent need to improve the heart health of Canadians."

To understand Canadians' level of heart health, a team of researchers developed the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) health index, which measures the ideal health behaviours and factors for optimal heart health. They looked at data on 464 883 people aged 12 years and older who participated in the Canadian Community Health Survey in which people answered questions about their health, health activities and use of health care services between 2003 and 2011.

Participants were categorized into two groups: adults aged 20 years and older and youth aged 12 to 19 years. Adults received scores ranging from worst (0) to best (6), whereas youth received scores between 0 and 4 (best). Ideal heart health was defined as a score of either 6 on the adult index or 4 on the youth index.

The CANHEART index looked at six ideal heart health behaviours and factors:

• Smoking: nonsmoker or former smoker who quit more than a year ago in adults; never tried smoking or never smoked a whole cigarette for youth
• Overweight/obesity: body mass index less than 25; age- and sex-specific cut-offs for youth
• Physical activity: for adults, at least 30 minutes of walking per day; for youth, at least 1 hour of walking or 20 minutes running/jogging each day
• Fruit and vegetable consumption: at least five times a day
• Hypertension: no high blood pressure
• Diabetes: no diabetes

The good news? Over the study period, more people were eating fruits and vegetables at least five or more times a day, there was a trend toward increasing physical activity (about 0.5% each year), and smoking decreased each year. The bad news? Increasing trends of overweight/obesity, hypertension and diabetes in adults and overweight/obesity in youth.

Women had better heart health scores than men and were three times more likely to be in ideal heart health between the ages of 40 and 49 years than men. More than one-third (37.3%) of Canadian adults were in poor cardiovascular health, and only 9.4% were in ideal cardiovascular health. For youth, about half (49.7%) were in poor cardiovascular health with only 16.6% in ideal cardiovascular health.

As people aged, heart health decreased, perhaps because of weight gain and development of hypertension and diabetes as reported in previous studies.

"Ninety per cent of Canadians have at least one heart health risk factor that could be modified by addressing behaviours that can affect cardiac risk," says Dr. Tu.

People in British Columbia scored the highest; the lowest scores, denoting the poorest cardiovascular health, were in Newfoundland and Labrador on the east coast. The trend toward poorer heart health was consistent from west to east.

Reducing Canadians' risk is more urgent than ever, because heart disease and stroke still take one life every seven minutes in Canada.

"Up to 80% of premature heart disease is preventable," says Heart and Stroke Foundation of Canada President Bobbe Wood. "Unfortunately, almost 4 in 10 of us are in poor health. The good news is that by adopting healthy behaviour now, many Canadians can considerably reduce the effects of heart disease and stroke."

The Heart and Stroke Foundation of Canada will use the CANHEART index to track and measure progress toward its impact goal to significantly improve the health of Canadians by decreasing their risk factors for heart disease and stroke by 10% by the year 2020. This will complement the foundation's impact goal to reduce Canadians' rate of death from heart disease and stroke by 25% by 2020.

"The CANHEART health index will be a useful tool for members of the general public, clinicians, researchers, chronic disease organizations and decision-makers interested in monitoring cardiovascular health and reducing the burden of chronic noncommunicable diseases in Canada," the authors conclude.