Regional Variations in Care Linked to Heart Attack and Stroke Risk
Despite Canada’s universal health insurance system, the use of certain preventive health services differs significantly between Ontario’s local health integration networks (LHINs). This difference accounts for about 15% of the difference in heart disease events—including heart attack, stroke and deaths from heart disease—between the areas, according to a new study.
Researchers from the Canadian Cardiovascular Health in Ambulatory Care Research Team looked at data from 5.5 million Ontarians aged 40 to 79 who had never had a hospital stay for heart disease at the start of the study.
Over five years, cardiovascular event rates varied almost twofold between the LHINs with the highest and lowest rates. Although people living in LHINs with high event rates were more likely to be obese, to smoke and to eat fewer fruits and vegetables, they were also less likely to see a doctor regularly, to be screened for heart disease and to keep cholesterol and blood pressure within target limits.
“The lower numbers of [doctor] visits may reflect differences in health-seeking behaviour between residents of different LHINs, but they may also reflect differences in access to care,” including the challenges Ontario has experienced recruiting and retaining primary care physicians to northern and more rural parts of the province, wrote the study authors.
- Read the full article in the Canadian Medical Association Journal
How Diabetes May Increase Heart Attack Risk
Patients with diabetes are known to be at increased risk for a heart attack. Researchers at the Technical University of Munich think they have identified one of the drivers of this risk: a reduction in the number of small blood vessels around the heart caused by elevated blood sugar levels.
The team first noticed the loss of small vessels in hearts taken from diabetes patients undergoing heart transplantation. In follow-up laboratory experiments, they saw that high blood sugar levels were associated with the loss of a type of cell known as a pericyte. These cells normally wrap around and stabilize the small blood vessels.
In animal models, the researchers confirmed the loss of small blood vessels in the heart over time with exposure to high blood sugar. And in experiments with diabetic pigs, the researchers were able to use a genetic therapy to stimulate the re-growth of pericytes and, in turn, some of the small blood vessels.
Though such gene therapy is not ready for use in humans, this research “reinforces our awareness of how important it is to diagnose diabetes early,” said Christian Kupatt, MD, the study’s senior author, in an accompanying press release.
- Read more about diabetes and heart disease