1 Cardiovascular Disease

Cardiovascular disease (CVD) refers to a wide range of conditions that are caused by atherosclerosis. Atherosclerosis is when plaque builds up in the walls of arteries, which narrows the arteries and makes it harder for blood to flow back to the heart (American Heart Association, 2017). There are many types of cardiovascular disease, including coronary heart disease, heart failure, and stroke (New York State Department of Health, 2012). CVD is the leading cause of death for all adults in the U.S., and the mortality rate is higher in men than in women. In the U.S., CVD causes 1 in 3 deaths each year, adding up to more than 859,000 people per year, and CVD costs $216 billion in health care system per year (NCCDPHP, 2022).

Common risk factors for development of CVD are high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking, obesity, an unhealthy diet, and physical inactivity. High blood pressure, defined as 130/80 mm Hg or higher, contributes to CVD because it damages the inner lining of arteries making them more susceptible to the buildup of plaque, which narrows the arteries that leading to the heart and brain, reducing blood supply. High LDL cholesterol can double a person’s risk of CVD. Excess cholesterol builds up in arterial walls, limiting blood flow to the heart, brain, kidneys, and legs. Diabetes leads to risk factors such as hypertension and increased triglycerides and LDL cholesterol, and adults with diabetes are twice as likely as non-diabetics to have heart disease or a stroke (NCCDPHP, 2022). Obesity can contribute to CVD because it can raise triglyceride and LDL cholesterol levels, while simultaneously lowering HDL cholesterol (“good” cholesterol) levels (Penn Medicine, 2022).

“Blood Pressure 365.364” by loonyhiker, Flickr is licensed under CC BY-NC-ND 2.0

This image depicts a man getting his blood pressure checked in a pharmacy. Blood pressure checks are important for

health because high blood pressure increases one’s risk of developing CVD. 

Luckily, many CVD risk factors are preventable; there are many ways to reduce one’s risk of developing CVD. For example, high blood pressure and cholesterol levels can be improved by eating a healthy, low-sodium diet, engaging in regular physical activity, maintaining a healthy weight, and following a recommended medicine regime (NCCDPHP, 2022).

Men generally develop CVD earlier in their lifespan than women, by about 10 years, and have a higher risk of coronary heart disease (CHD) than women. CVD is the leading cause of death for men in the United States, accounting for about 1 in every 4 male deaths in 2020 (Centers for Disease Control and Prevention, 2022). Special CVD risks in men include increased stress, low testosterone, and erectile dysfunction. Stress and anger raise both blood pressure and stress hormones, which restricts blood flow to the heart. Additionally, effects of chronic stress and anger can build up over time, which damages arteries and increases risk of developing CVD. Low testosterone is linked to CVD and is considered to be a cardiovascular and metabolic risk factor. Erectile dysfunction is an indicator of overall cardiovascular health because the penis is a vascular organ. This is because the arteries in the penis are much smaller than those in the heart, so arterial damage can be noticed here first, often years before other CVD symptoms present (Johns Hopkins Medicine, 2022).

Disparities in Race and Socioeconomic Status

Beyond biological sex, race and socioeconomic status (SES) are also associated with disparities in CVD risk and prevalence among men. Socioeconomic status refers to one’s position in society and is derived from a combination of social and economic factors such as income, education, and occupation.

Though over the years CVD mortality rates have been on the decline, racial disparities still exist (Ferdinand et al., 2017). Ethnic and racial minority groups have higher rates of CVD and related risk factors because they encounter more barriers to CVD diagnosis, receive lower quality health care, and face poorer health outcomes (Ski et al., 2014). Black men are 2 to 3 times more likely than White men to die from preventable heart disease and stroke (Ferdinand et al., 2017). Hispanic men have increased rates of CVD risk factors, yet lower rates of overall CVD. Increased CVD risk factors include elevated body mass index, with up to 75% of Mexican American men being obese or overweight, and increased prevalence of diabetes and hypertension when compared to non-Hispanic White men (Graham, 2015). Asian American men have a lower likelihood of developing CVD, and a lower likelihood of dying from CVD. In fact, Asian American men are 50 percent less likely to die due to CVD than non-Hispanic white men. This can likely be attributed to lower rates of obesity and hypertension, and cigarette smoking  in Asian American men as compared to other male populations (U.S. Department of Health and Human Services Office of Minority Health, 2021).

Men who are socioeconomically disadvantaged experience increased rates of CVD. Over the past 50 years, this disparity in CVD rates between low SES and high SES men has widened (Ski et al., 2014). With occupation, a related risk factor for CVD is work stress. Those with high levels of work stress, including job strain and extensive work hours, are at an elevated risk of coronary heart disease and stroke. Work stress increases the risk of many chronic illnesses in addition to CVD, and this link can be seen across race and sex (Kivimaki & Kawachi, 2015). Additionally, those who have higher levels of occupational physical activity are seen to have higher levels of CVD. While physical activity is generally known to benefit cardiovascular health and lower the risk of CVD, increased rates of occupational physical activity, as seen in many blue-collar occupations, is detrimental to cardiovascular health and overall health. Contrastingly, those with increased levels of leisure-time physical activity have lower rates of CVD (Quinn, 2021). The reason for this difference in cardiovascular health outcomes has to do with the type of physical activity performed. Leisure-time physical activity typically involves dynamic movements performed at intense levels. This type of activity improves cardiorespiratory fitness and is usually done voluntarily over short periods of time which allow enough time for recovery in between. In contrast, occupational physical activity often requires static loading, heavy lifting, awkward posture, and other activities that don’t actually improve fitness performed over long periods of time without sufficient recovery time (Holtermann et al., 2018).

“Construction workers at project construction site” by World Bank Photo Collection, Flickr is licensed under CC BY-NC-ND 2.0

This image depicts four men working at a construction site. Increased levels of occupational physical activity, like the type of physical activity

done at construction sites, is detrimental to cardiovascular health and overall health. 

In general, those with higher incomes have lower rates of CVD. However, significant changes in one’s income can also affect individuals’ susceptibility to CVD. Considering a 50% increase or decrease in income to be a significant income rise or income drop, it was found that an income drop over 6 years was associated with higher risk of developing CVD, while an income rise over 6 years was associated with lower risk of developing CVD (Wang et al., 2019).

Racial disparities in CVD risk factors between Black and White men also still exist across socioeconomic status. Black men had an increased likelihood of having hypertension, diabetes, and obesity when compared to Whites, among those at an income level of $100,000 or higher. These are all significant risk factors for CVD and can lead to poorer health outcomes in Black men. These disparities in CVD risk factors were not seen among those in the lowest SES groups. This data suggests that African American men experience fewer health benefits from increased income level than White men (Bell et al., 2018).

There are many factors that may contribute to why these disparities across the intersections of race, occupation, and income may exist. For lower SES groups, poorer CVD outcomes may be attributed to increased exposure to cardiovascular risks such as smoking, excess alcohol consumption, physical inactivity, and poor diet. Additionally, men in low SES groups often have less access to medical care and social support, increased co-morbidity and job stress, and are less likely to engage in health-seeking behaviors than men in higher SES groups (Ski et al., 2014).

Call To Action

Death rates from CVD have declined over 70% since the 1960s due to improvements in prevention and treatment, but this decline in mortality has begun to flatten. CVD is still the leading cause of death in the United States. The Healthy People Initiative is a national health agenda from the U.S. Department of Health and Human Services that establishes nationwide health improvement priorities and goals for each decade (Pahigiannis et al., 2019). Healthy People 2030 includes goals for preventing and treating CVD and improving overall cardiovascular health, as well as goals for improving men’s health (Heart disease and stroke). Currently there are separate Healthy People goals for CVD and for men, but combining these into male-specific CVD goals would be beneficial in order to create interventions for specific male demographics.

Additionally, many research findings that have led to overall improvements in CVD rates have not been effectively translated into clinical practice and public health (U.S. Department of Health and Human Services, 2021). To improve the CVD outcomes, policymakers and practitioners need to implement effective and accessible strategies that help prevent, treat, and control CVD and risk factors. This also includes promoting good cardiovascular health practices from boyhood to manhood to create positive habits that will lead to improved health outcomes. Lifestyle factors contribute greatly to CVD outcomes, and this is where many prevention programs should focus. More importantly, there should also be a focus on accessibility and adaptability of lifestyle improvements. For example, explaining alternatives for recommendations to have a better diet and increased exercise for those who may not have access to healthy grocery stores or safe environments to walk in.

There are several countries across the globe where cancer has passed CVD as the leading cause of death, indicating a decrease in CVD (Howard, 2019). This transition is due to improved prevention and treatment practices, and can hopefully be replicated in the U.S. in the near future.

Chapter Review

References

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