Sustainable Development Goals and Suggestions to Reduce Cardiovascular Disease Risk Factors

Aggeliki Vakka (1), Nikolas Sevdalis (2)

1: University of Patras, Faculty of Medicine, Greece

2: Medical University of Sofia, Faculty of Medicine, Bulgaria

The Sustainable Development Goals are a collection of 17 global goals set by the United Nations General Assembly in 2015 for the year 2030 in order to ensure sustained and inclusive economic growth, social inclusion, environmental protection and peace. The third of these 17 goals is good health and well-being. Since cardiovascular diseases are the leading cause of death globally, it is important to examine how various economic, social and environmental factors are related to this increasing rate of cardiovascular diseases.

Cardiovascular diseases are conditions affecting the heart or blood vessels. They resulted in 17.9 million deaths (31%) in 2016, up from 12.3 million (25.8%) in 1990. Three quarters of CVD deaths occur in low and middle-income countries. CVDs remain prominent in high income countries as well, accounting for 45% of the deaths in the geographical region of Europe in 2017 (3.9 million) and an estimated 1 in 2 adults in the United States having some sort of CVD disease, which translates to 837,000 deaths (33%).  (1, 2, 3)

There are many risk factors associated with CVDs. Some risk factors cannot be modified, such as increasing age, male gender and heredity, while other risk factors can be modified, such as high blood LDL levels, high blood pressure, diet, physical inactivity and tobacco use. Staying true to the Sustainable Development Goals blueprint, we shall take into consideration the economic, the social and the environmental components when discussing CVD risk factors.  (4)

The economic inequalities lead to inadequate access to healthy food and medical care. People with low income are more susceptible to follow an unhealthy diet and consume fast food, since it is cheaper. This kind of diet, high in saturated fat, is estimated to cause about 31% of coronary heart disease and 11% of stroke worldwide. Sodium is also associated with hypertension, which is harmful for the blood vessels. Furthermore, people who live in poverty face greater barriers to accessing medical care. They are less likely to have health insurance and receive new drugs, since they cannot afford them. (2, 5)

Modern lifestyle is characterized by adopting an unhealthy diet, lack of physical activity, anxiety and smoking, which leads to the development of CVDs.  Nowadays, physical exercise is less common especially in urbanized countries. This sedentary lifestyle is combined with the consumption of fast food. In addition to that, the rat race in almost every working environment causes stress. Some scientists have noted a correlation between coronary heart disease risk and stress in a person’s life. Possible mechanisms by which stress confers risk include dysregulation of the hypothalamic-pituitary-adrenal axis and inflammation. Moreover, people under stress may overeat, drink alcohol, start smoking or smoke more than they otherwise would. Also, another risk factor of CVDs is tobacco use. Smoking is estimated to cause more than 8 million deaths each year. More than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of passive smoking.  (6, 7)

Environmental exposure is an important but underappreciated risk factor contributing to the development of cardiovascular diseases. Pollutants enter the body through dermal absorption, inhalation or ingestion. They can interact with organs and tissues, alter cell signalling and gene expression and cause inflammation. Pollutants may lead to subclinical changes (such as alterations in cardiac structure and function) or cardiovascular diseases (such as ischemic events, arrhythmia events and cardiomyopathies).   (8)

Taking into consideration these risk factors for CVDs, the 2030 Agenda for Sustainable Development includes the SDG 3 about “good health and well-being”. Non communicable diseases (NCDs) including CVD have been included as a particular target in SDG goal 3. Specifically, SDG target 3.4 aims to reduce by one third premature mortality from non-communicable diseases through prevention and treatment. As for the economic inequalities, SDGs target 3.8 addresses universal health coverage, including financial risk protection, access to quality essential health-care services and access to quality and affordable essential medicines and SDGs target 3.D aims to strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.  SDGs target 3.5 aims to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol, while SDGs target 3.A addresses the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries. In this way, some of the social risk factors which lead to CVDs may be reduced.  As for the environment, SDGs target 3.9 calls for the reduction of the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.  

It is clear that these targets aim to reduce plenty of the CVDs’ risk factors in a theoretical frame. However, these goals cannot be achieved without the personal action of all of us. In order to decrease these increasing rates of CVDs, a healthy diet, exercising, quitting smoking, abstention from consuming excessive amounts of alcohol and protecting the environment is necessary. Moreover, we should fight for the elimination of economic inequality and the assurance of every person’s human rights to food and health. Also, education can play a significant role in the decrease of CVDs by pointing out the importance of having a healthy lifestyle, fighting for equal rights and protecting the environment. Last but not least, the medical and scientific community ought to keep conducting research and informing people about its results. 

All in all, there are economic, social and environmental risk factors that lead to the development of CVDs and the SDGs focus on how to reduce them. However, these targets will not be reached without our personal action. Collective efforts of the United Nations, the medical and scientific community, the state, the educational system and each one of us can limit these risk factors and lead to a healthier world.  

References:

  1. European Cardiovascular Disease Statistics 2017, European Heart Network. Retrieved from http://www.ehnheart.org/cvd-statistics.html
  2. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association., Circulation, 2018
  3. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet, 2016
  4. 2016 European Guidelines on cardiovascular disease prevention in clinical practice, Eur Heart J., 2016
  5. Economic issues drive disparities in heart disease, American Heart Association News, 2018. Retrieved from: https://www.heart.org/en/news/2018/05/10/economic-issues-drive-disparities-in-heart-disease-stroke
  6. Stress and Inflammation in Coronary Artery Disease: A Review Psychoneuroendocrineimmunology-Based, Fioranelli M. et al., Front Immunol., 2018
  7. Tobacco, WHO, 2019. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/tobacco
  8. Environmental factors in cardiovascular disease, Cosselman K et al., Nat Rev Cardiol., 2015

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