Unhealthy housing can lead to an unhealthy heart

Lack of access to quality housing can be a steady stressor that increases the risk factors for heart attacks, strokes and other cardiovascular issues, according to a new report.

"Chronic housing insecurity may impact a person's ability to eat properly, get quality sleep, schedule regular medical care or fill prescriptions due to cost," Mario Sims, chair of the writing group for the American Heart Association scientific statement, said in a news release. The work – a review of the current research on housing's impact on cardiovascular disease – was published Wednesday in the AHA's journal Circulation: Cardiovascular Quality and Outcomes.

"These factors all contribute to inadequate treatment to reduce cardiovascular risk factors such as high blood pressure, high cholesterol and tobacco use, and to the greater likelihood of having a cardiovascular event such as a heart attack or stroke," said Sims, a professor at the University of Mississippi Medical Center in Jackson. He also serves as chief science officer of the Jackson Heart Study, the largest research project to date looking at the causes of cardiovascular diseases in African Americans.

People are considered homeless, as defined by the federal government, if they live on the street, are serial renters who move often, or temporarily live in hotels, homeless shelters or with friends.

"The disparities in cardiovascular health among people who are homeless and marginally housed are largely due to psychosocial stressors, unhealthy behaviors used as coping mechanisms and barriers to health care, including lack of insurance and stigmatization among this population," Sims said.

Among adults who were homeless or housing insecure:

– 60% of their cardiovascular disease-related deaths are caused by smoking

– 25% report recent cocaine use, which increases risk of heart attack

– 25% have mental illness, which may contribute to delayed diagnosis and fragmented medical care

Poor quality of housing, residential segregation and bias contribute to the problem.

Houses that are deteriorating, that don't heat or cool well or leave residents exposed to pollutants such as mold, lead or secondhand smoke can impact cardiovascular disease risk. Improving air quality, reducing dampness and living in a comfortable temperature have been shown to lower blood pressure.

Studies have found that adults who live in older public or low-income housing are more likely to have heart disease. Substandard living conditions affect mental health, which also has been linked with heart and blood vessel health in both children and adults.

Residential segregation by race and ethnicity as well as gentrification – when more affluent people renovate in neighborhoods and displace lower-income residents – also can make it harder to find affordable, high-quality housing.

The scientific statement looked at how the 2007-2010 foreclosure crisis was associated with poorer heart health, and it highlighted racial disparities. Hispanics in areas at risk for foreclosure had higher rates of high blood pressure and high cholesterol. Foreclosures also were associated with higher rates of heart attacks and strokes among middle-aged Black residents.

"Neighborhood environments are strong predictors of cardiovascular health and well-being," Sims said. "Studies have consistently shown that individuals residing in economically distressed neighborhoods with high poverty and unemployment rates have a higher incidence of cardiovascular risk factors, including obesity, diabetes, hypertension and heart disease, and higher risk of stroke and death from a cardiovascular disease such as heart attacks, strokes, heart failure and others."

The way neighborhoods are designed even has an impact, the report said.

Walkability and access to healthy food options are tied to body mass index, blood pressure, Type 2 diabetes and a cluster of heart disease risk factors called metabolic syndrome. Research suggests high levels of neighborhood greenness, or vegetation, are associated with lower rates of Type 2 diabetes, heart attack, coronary artery disease and heart failure.

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