Karolay Lorenty

Reframing cardiovascular disease

29 September 2023

If heart health were only a matter of lifestyle, then heart disease would be a personal – rather than policy – issue. But it’s not that simple.

Despite being the leading cause of death worldwide, cardiovascular diseases have not received as much attention as other public health issues such as cancer. Notably, the European Union pledged to improve the prevention and care of cancer with the publication of Europe’s Beating Cancer Plan in 2021, while the cardiovascular disease community has yet to see such a commitment.

So what is behind the lack of political action? It may reflect the perceptions of the wider population. Cancer incites fear. It is seen as an enemy that unpredictably arises from the outside and has devastating consequences for the people affected, as well as their loved ones. In comparison, heart disease is often seen as something that is more under one’s personal control; it does not seem to create as strong a sense of fear as cancer, even among people living with known risk factors.

People tend to be aware of the role of lifestyle in the prevention of cardiovascular disease. When it comes to cancer, however, prevention is often overlooked and genetics are seen as a key cause. In reality, up to 50% of cancer cases are said to be preventable. Smoking, alcohol and obesity are the biggest contributors to cancer across the world – and these risk factors are all shared with cardiovascular disease.

Policymakers are likely not exempt from these perceptions, which influence their sense of urgency and impact decision-making. Public health officials across Europe rate the attitude within the population as the most important obstacle to improving cardiovascular health, rather than political or organisational factors.

Stigma in cardiovascular disease is life-threatening. It can drive people to hide their condition, prevent them from seeking healthcare and discourage them from adopting healthy behaviours.

What is the role of stigma?

Many of the risk factors for heart diseases are modifiable via changes to one’s lifestyle, which may seem like good news: if we are in control of our own cardiovascular health, then there is nothing to fear. But what seems at first a well-intentioned effort to promote healthy living can quickly become a source of blame and stigma.

Stigma in cardiovascular disease is life-threatening. Not only does stigma lead to people with a disease being stereotyped and discriminated against, it can also drive them to hide their condition, prevent them from seeking healthcare and discourage them from adopting healthy behaviours. A US study found that 1 in 4 women thought heart disease was embarrassing, as they felt other people assumed that it meant they were not eating well or exercising. Women are frequently told to lose weight rather than receiving a comprehensive risk factor assessment. In a study of Black women with hypertension, 40% reported that stigma or shame was associated with their condition, with nearly 33% of them hiding their diagnosis.

While it is important that people recognise and take charge to manage their modifiable risk factors, there is nothing empowering about blame. All too often, it has been used as an excuse to neglect people and limit much-needed support.

If we want to hold our health policymakers accountable and improve political action for cardiovascular disease, we need to shift the focus away from lifestyle.

Shifting perceptions of cardiovascular disease

Would you say to someone with cancer that they should have eaten better and exercised more to prevent it? Probably not. So how can we stop this from happening to people with cardiovascular disease?

We need balanced messaging that acknowledges the disease’s severity and complexity. Cardiovascular disease predominantly affects older people, yes. But so does cancer. The risk of cardiovascular disease can be reduced with lifestyle changes, yes. The same can be said for cancer. And, importantly, cardiovascular disease can be just as malignant as cancer.

Aside from an unhealthy diet and physical inactivity, there are many other risk factors that influence the development of cardiovascular disease. Researchers are only starting to disentangle the complex interaction between genes and the environment. Stress is an independent predictor of cardiovascular disease, while low educational attainment explains up to one third of the higher mortality rate among people with cardiovascular disease.

If we want to hold our health policymakers accountable and improve political action for cardiovascular disease, we need to shift the focus away from lifestyle. Instead, it must be more widely recognised and acknowledged that complex social, economic and biological factors underlie cardiovascular disease.

Reframing cardiovascular disease

If heart health were only a matter of lifestyle, then heart disease would be a personal – rather than policy – issue. But it’s not that simple.

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What is the role of stigma?

Shifting perceptions of cardiovascular disease

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.