





































       V39 N4 / 2024 

©2024 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     48

ABSTRACT 
The purpose of this article is to examine the influence of 
social determinants of health on the global health problem 
of cardiovascular disease (CVD), particularly focused on 
the Americas region. CVD, which encompasses conditions 
such as coronary heart disease, heart failure, and cerebral 
vascular disease, is identified as the leading cause of mor-
tality worldwide, with low- and middle-income countries 
bearing the brunt of its burden. The article discusses how 
factors such as economic status, education, environment, 
food supply, substance addiction, and health care accessi-
bility contribute to the prevalence of CVD. Additionally, it 
explores current public health policies addressing CVD and 
provides recommendations for enhancing these policies to 
alleviate the burden of the disease. The recommendations 
include implementing tobacco control policies, raising the 
legal age for purchasing tobacco products, and advocating 
for comprehensive health care services. The article con-
cludes by emphasizing the importance of tailored interven-
tions, evidence-based policies, and evaluation strategies in 
combating CVD and improving public health outcomes.

According to the World Health Organization,1 cardiovas-
cular disease (CVD) is the leading cause of morbidity and 
mortality that affects the worldwide population. This broad 
category of diseases encompasses coronary heart disease, 
heart failure, cardiomyopathy, cerebral vascular disease, 
and congenital heart disease.2 Atherosclerosis, character-
ized by the narrowing of arteries due to plaque formation, is 
identified as a primary underlying cause of CVD. This con-
dition is exacerbated by chronic stress and elevated serum 
levels of cholesterol and triglycerides, leading to a build-up 
of atheroma within the coronary arteries, reducing blood 
supply to the myocardium, and potentially causing isch-
emia, myocardial infarction, and angina.2

 Currently, CVD accounts for 31% of the overall global 
deaths. However, CVD is not considered to just be a pre-
dominant health issue in developed countries; research 

suggests that low- and middle-income countries have a 
higher susceptibility to the disease, accounting for 80% of 
these total deaths.3 This disparity highlights the significant 
role that social determinants of health play in influencing 
CVD outcomes.
 Economic status, education, environment, food supply, 
substance addiction, and accessibility to health care ser-
vices are pivotal factors that shape the risk and progression 
of CVD. Poverty and income inequality can limit access 
to health care services, healthy food, and education, all of 
which are crucial for preventing and managing CVD. Lower 
levels of education are linked to poorer health outcomes, 
increased stress, and lower self-confidence, which can con-
tribute to higher CVD risk. Environmental factors, including 
climate change and urbanization, influence lifestyle behav-
iors and access to resources necessary for maintaining car-
diovascular health. Diets high in energy-dense, nutrient-poor 
foods contribute to obesity, diabetes, and other conditions 
that elevate CVD risk, whereas diets rich in whole grains, 
fruits, vegetables, and lean proteins are protective against 
CVD. Tobacco use, excessive alcohol consumption, and illicit 
drug use are significant risk factors for CVD, leading to con-
ditions such as atherosclerosis, hypertension, and cardiomy-
opathy. Additionally, limited access to health care services 
hinders early detection, effective treatment, and ongoing 
management of CVD, particularly in smaller or economi-
cally disadvantaged nations. Addressing these determinants 
through effective public health policies is crucial for reducing 
the burden of CVD, particularly in the Americas.
 The purpose of this article is to investigate the impact of 
social determinants of health on the prevalence and burden 
of CVD in the Americas. It aims to explore how economic 
status, education, environment, food supply, substance 
addiction, and health care accessibility contribute to the 
occurrence of CVD. Additionally, the article evaluates cur-
rent public health policies addressing CVD and proposes 
recommendations to enhance these policies to mitigate the 
disease’s impact in the region. Current strategies include 
tobacco control policies, raising the legal age for purchasing 

Alan Silburn, MPH, BP, BN, FAWM / Western Sydney University, Campbelltown, Australia

Cardiovascular Disease in the Americas: Social Determinants,  
Public Health Policies, and Recommendations (Part 1)

SCIENCE SERIES

http://www.amwajournal.org


AMWAJournal.org     49Cardiovascular Disease in the Americas (Part 1)

tobacco products, and advocating for comprehensive  
health care services. These interventions aim to mitigate  
the risk factors associated with CVD and improve public 
health outcomes.
 The scope of this article encompasses a comprehen-
sive analysis of CVD within the Americas, identifying and 
evaluating the social determinants of health that impact 
CVD prevalence. It provides an overview of CVDs and the 
mechanisms through which they develop. The article exam-
ines the disparities in CVD prevalence across different eco-
nomic, educational, and environmental contexts within the 
Americas. Furthermore, it reviews existing public health 
policies targeting CVD and offers evidence-based recom-
mendations to improve these policies. The article concludes 
with insights for health education specialists and health 
promotion professionals, emphasizing the importance of 
tailored interventions, evidence-based policies, and eval-
uation strategies in combating CVD and enhancing public 
health outcomes.

CVD OVERVIEW
CVD is a collective term that encompasses the diseases of 
the heart and blood vessels. It commonly includes a range 
of conditions such as coronary heart disease, heart failure, 
cardiomyopathy, cerebral vascular disease, and congenital 
heart disease.2 For most CVD presentations, atherosclero-
sis plays a pivotal role marked by arterial narrowing caused 
by accumulation of lipids, fibrous elements, and calcifica-
tion. Chronic stress, either mechanical or oxidative, can 
damage the inner arterial wall, facilitating the infiltration 
of macrophages and LDL-containing cholesterol and tri-
glycerides. This process is expedited if serum levels are ele-
vated. Foam cell formation progresses into fatty streaks, and 
subsequent smooth muscle cell migration and extracellular 
matrix deposition lead to the formation of a fibrous plaque. 
If destabilized, the fibrous plaque may rupture, resulting 
in a thrombus and possibly coronary artery occlusion. This 
buildup of atheroma within the coronary arteries reduces 
blood supply to the myocardium, potentially causing isch-
emia and leading to conditions like myocardial infarction 
and subsequent angina.2

CVD in the Americas
On a global scale, CVD constitutes 31% of total mortality 
rates. This prevalence is similarly observed across the 21 
countries in the Americas, where CVD accounts for 33.7% 
of annual deaths, maintaining its position as the leading 
cause of mortality.4 Broken down into 3 subregions, CVD 
is responsible for 22.8% of deaths in North America, 38% 
in Latin America, and 41.8% in the non-Latin Caribbean. 
Among individual countries, Venezuela, Guyana, and 

Trinidad and Tobago exhibit the highest CVD mortality  
rates, whereas Canada and Chile record comparatively 
lower rates.4

SOCIAL DETERMINANTS OF HEALTH AND CVD
Disparities in social determinants of health contribute 
to variations in health status within a country and across 
regions. According to the World Health Organization,5 
the social conditions in which people are born, live, and 
work are shaped by the distribution of money, power, and 
resources at local, national, and global levels. These factors, 
collectively known as the social determinants of health, play 
a crucial role in determining an individual’s health status.
 Key social determinants such as the environment, edu-
cation, food supply, substance addiction, and lack of access 
to appropriate health care services significantly contribute 
to the burden of CVD in the Americas. These determinants 
influence modifiable risk factors for CVD, including psycho-
social stress, physical inactivity, poor diet, obesity, diabetes, 
smoking, and alcohol consumption.6

Economic Factors
Although CVD affects populations worldwide, significant 
disparities persist in its prevalence and epidemiology across 
countries with varying income levels. The World Bank7 clas-
sifies economies based on gross national income (GNI) 
per capita: low-income economies with a GNI per capita 
of $995 or less, middle-income economies with a GNI per 
capita ranging from $996 to $12,055, and high-income econ-
omies with a GNI per capita of $12,056 or more.7 These 
income classifications delineate the economic landscape 
within which CVD manifests.
 In the Americas, the economic status of a country does 
not necessarily correlate with the prevalence of CVD. Low-
income nations such as Haiti experience a substantial 
burden, with 24% of annual deaths attributed to CVD.7-8 
Similarly, middle-income countries like Venezuela and 
Guyana report significant CVD-related mortality, account-
ing for 30% and 33% of annual deaths, respectively.7,9,10 
Even higher-income countries such as Canada, Chile, and 
Trinidad and Tobago grapple with CVD, with reported 
mortality rates of 27%, 27%, and 32%, respectively.7,11-13 
Notably, comparing with a similarly high-income econ-
omy, Australia, where CVD constitutes 29% of total annual 
deaths, underscores the global impact of this disease.7

 Economic factors significantly influence the burden of 
CVD. Low-income countries often lack the health care infra-
structure necessary for effective prevention, diagnosis, and 
treatment of CVD, leading to higher mortality rates. Middle-
income countries may experience economic instability, 
which can hinder health care access and affordability,  

http://www.amwajournal.org


AMWAJournal.org     50Cardiovascular Disease in the Americas (Part 1)

exacerbating the prevalence of CVD. In high-income coun-
tries, although health care systems are more robust, dis-
parities within the population still exist, driven by income 
inequality, access to health care, and lifestyle choices.
 Income disparities not only shape national CVD prev-
alence but also reveal variations within countries. For 
instance, in Canada, regions like the Renfrew and Eastern 
Counties of the Champlain Region exhibit higher incidences 
of CVD mortality compared with the City of Ottawa.14,15 This 
disparity hints at underlying social determinants influenced 
by income, potentially affecting access to health care, life-
style choices, and environmental factors.
 Similarly, in the United States, where CVD accounts 
for nearly 25% of all deaths, specific regions bear a dis-
proportionate burden. States like Kentucky, West Virginia, 
and Louisiana, situated in the southern Atlantic, report the 
highest CVD-related deaths per capita.16 These states typi-
cally have lower incomes, higher poverty rates, and limited 
access to health care, which hinders the prevention and 
effective management of CVD.17 These disparities reflect 
complex interplays between income, access to health care 
resources, education, and lifestyle factors—all of which con-
tribute to the economic link to CVD.

Education
Likewise, to a country’s economic landscape, education 
is a social determinant of health because low education 
levels have been linked with poor health status, increased 
stress, and lower self-confidence.6 Specifically, education 
has been inversely associated with CVD.18 This concept is 
supported by prior research designs in which individuals 
with lower education attainment displayed a heightened 
cardiovascular risk compared with those with higher levels 
of education.19,20 This observation may elucidate the higher 
occurrence of CVD in countries with lower average educa-
tion attainment, such as Venezuela and Guyana, in contrast 
to countries like Canada and Chile.21

Environment
A nation’s environment refers to the natural and physical 
aspects of the area encompassing the climate, soil, water, 
and geographical position, all of which significantly influ-
ence the health determinants of the respective popula-
tion. Firstly, the environmental climate plays a pivotal role 
in daily life and is highly sensitive to changes. Alterations 
in climate patterns can escalate the severity or frequency 
of health issues influenced by weather conditions, poten-
tially leading to unforeseen health challenges in previously 
unaffected regions.22 The World Health Organization1 has 
highlighted the escalating global temperatures, particularly 
evident near the equator, as a concerning trend. Such tem-

perature rises have been linked to exacerbating preexisting 
cardiovascular issues like CVD due to intense heat exposure 
and undernutrition.23 This connection is particularly worry-
ing because it could contribute to the surge in CVD-related 
hospitalizations observed in equatorial countries like Brazil 
from 2007 to 2012.24

 Likewise, temperature fluctuations, especially rising 
temperatures, pose complex risks to cardiovascular health 
and nutritional well-being. Intense heat exposure can strain 
cardiovascular systems, particularly in individuals already 
predisposed to cardiovascular issues.23 Moreover, rising 
temperatures can exacerbate undernutrition by affect-
ing agricultural productivity, food availability, and nutri-
tional quality, thereby further compromising cardiovascular 
health. This dual impact underscores the intricate relation- 
ship between environmental factors, health outcomes, 
and the imperative need for comprehensive approaches to 
address these challenges.
 Also, a nation’s geographical location can foster psycho-
social factors such as social isolation, also known as social 
disconnectedness. This isolation can profoundly impact an 
individual’s mental well-being and elevate the risk of engag-
ing in unhealthy behaviors.25 Given that health is defined as 
a state of complete physical, mental, and social well-being, 
not merely the absence of disease, mental health directly 
influences an individual’s vulnerability to CVD.18,26

Food Supply
Furthermore, the type of food supply and its availability  
can determine the health of an individual or country. 
Evidence suggests that a poor-quality diet consisting of 
excessive energy-rich foods, refined grains, added sugars, 
high salt content, and unhealthy fats can encourage weight 
gain, obesity, and diabetes and can have an influence on 
CVD.27,28 These diets often include a high volume of pro-
cessed food products that sacrifice nutrition for conve-
nience. Opposingly, a healthy diet consists of whole grains, 
fruits, vegetables, legumes, fish, and nuts. Food supply and 
diets are facilitated by modern food environments that have 
influenced the prevalence of CVD in the Americas because 
the food systems that were once dominated by local produc-
tion and markets containing foods requiring little processing 
before reaching the household have shifted toward maxi-
mizing production efficiency to reduce cost and increase the 
convenience for the consumer, thus sacrificing the food’s 
nutritional value.28

Substance Addiction
Substance addiction, particularly through smoking and 
excessive alcohol consumption, significantly exacerbates 
the risk and progression of CVD. The consumption of addic-

http://www.amwajournal.org


AMWAJournal.org     51Cardiovascular Disease in the Americas (Part 1)

tive substances leads individuals into cycles of dependency, 
often precipitated by social disintegration and stressors.29 
These dependencies not only perpetuate existing health 
disparities among different demographic groups but also 
contribute significantly to the escalation of CVD. This con-
nection is particularly notable as substance abuse can 
directly exacerbate risk factors associated with CVD, such as 
hypertension and atherosclerosis, thereby magnifying both 
the prevalence and severity of cardiovascular health issues 
within affected populations.
 Smoking, for instance, plays a pivotal role in all phases 
of atherosclerosis development, a primary precursor to 
CVD. It triggers the release of inflammatory markers and oxi-
dative stress, which collectively contribute to endothelial dys-
function and vascular damage. Nicotine, a key component 
in cigarettes, further aggravates the situation by constricting 
blood vessels, thereby increasing blood pressure and heart 
rate. These physiologic changes foster the formation of  
arterial plaques and accelerate the progression of atheroma, 
narrowing crucial blood vessels and compromising blood 
flow to the heart and other vital organs.30 In the context of 
public health, substance addiction significantly adds to the 
prevalence of CVD. For instance, in Brazil, it is known that 
50% of the deaths of smokers, most of which are caused by 
CVD, could be prevented with smoking cessation.31

 Similarly, excessive alcohol consumption, defined as 3 or 
more drinks per day, has been linked to various cardiovas-
cular complications, including hemorrhagic strokes, cardio-
myopathy, ischemic heart disease, and hypertension. These 
conditions not only increase the immediate risk of cardio-
vascular events but also contribute to the chronic burden of 
CVD over time.30 This underscores the critical importance 
of addressing substance addiction as a key modifiable risk 
factor in reducing the burden of CVD globally.

Health Care Accessibility
Health care accessibility is not only crucial but fundamen-
tally essential for promoting cardiovascular health across 
populations. Access to health care services directly influ-
ences the prevention, diagnosis, treatment, and man-
agement of CVD.31 It enables widespread adoption of 
preventive measures such as regular screenings for risk 
factors like high blood pressure and cholesterol, as well as 
education on lifestyle changes like diet improvements and 
smoking cessation. Timely access to health care facilities 
allows for early detection through diagnostic tests facilitat-
ing prompt intervention when abnormalities are identified. 
Comprehensive treatment options, including medications, 
surgical interventions, and specialized cardiac rehabilita-
tion programs, can then be implemented to manage cardio-
vascular conditions effectively.

 However, in many countries, especially those with lim-
ited health care infrastructure and resources, health care 
accessibility remains a significant challenge. An example 
of this can be witnessed in smaller countries such as Saint 
Kitts and Nevis, which have a total population of 55,000, that 
experience challenges in providing adequate CVD health 
care. For instance, less than 25% of the primary health care 
centers in the country offer CVD risk stratification services.32 
This in turn may justify the disproportionate death rates 
from CVD in 2021 between Saint Kitts and Nevis when com-
pared with the greater Americas region at 278 per 100,000 
and 149.9 respectively.33

 Access to effective and appropriate CVD health care ser-
vices is vital for maintaining individual, community, and 
national health. It serves as a foundation for implementing 
successful public health policies and strategies. Without suf-
ficient access to health care, efforts to prevent and manage 
CVDs can be significantly hampered.29

 Expanding on this, countries can enhance health pro-
motion and prevention by ensuring that health care facil-
ities offer comprehensive CVD services, including risk 
assessments, early detection, treatment, and ongoing man-
agement. Public health campaigns can also raise awareness 
about the importance of regular check-ups and early inter-
vention for cardiovascular health. Incorporating these strat-
egies into health care systems can improve CVD outcomes 
and contribute to overall public health.
 In Part 2, the impact of public health policies on CVD is 
explored. Effective public health policies create supportive 
environments to improve overall health by addressing social 
determinants like the economy, education, and health care 
accessibility. This section will cover the historical perspec-
tive of CVD policies, the US approach, and the effectiveness 
of tobacco control measures. In addition, recommendations 
for future actions and insights for health education special-
ists on designing, implementing, and evaluating interven-
tions to prevent CVD will be presented.

AUTHOR STATEMENT
This study did not require ethical approval as it involved a 
retrospective analysis of publicly available and anonymized 
data, with no direct involvement of human subjects.

Author declaration and disclosures: All individuals listed 
as authors participated sufficiently in the intellectual content, 
writing, and data analysis of the manuscript to assume public 
responsibility for the content therein; that all authors reviewed 
the final version prior to submission; and that any financial or 
personal relationships that might bias or be seen to bias their 
contributions to the work have been disclosed.

Author contact: alan.silburn@health.nsw.gov.au

http://www.amwajournal.org


AMWAJournal.org     52Cardiovascular Disease in the Americas (Part 1)

References
1.   Cardiovascular diseases. World Health Organization. Accessed 

October 16, 2023. https://www.who.int/health-topics/
cardiovascular-diseases#tab=tab_1

2.   What we’re doing about cardiovascular conditions. Australian 
Government Department of Health and Aged Care. Updated 
September 29, 2021. Accessed September 25, 2024. https://
www.health.gov.au/topics/chronic-conditions/what-
were-doing-about-chronic-conditions/what-were-doing-
about-cardiovascular-conditions?utm_source=health.gov.
au&utm_medium=callout-auto-custom&utm_campaign=digital_
transformation

3.  Ordúñez García P, Campillo-Artero C, eds. Regional Consultation: 
Priorities for Cardiovascular Health in the Americas. Key 
Messages for Policymakers. Pan American Health Organization; 
2011. Accessed September 25, 2024. https://iris.paho.org/
bitstream/handle/10665.2/50952/9789275132265_eng.
pdf?sequence=2&isAllowed=y

4.   Ordunez P, Prieto-Lara E, Pinheiro Gawryszewski V, Hennis A, 
Cooper R. Premature mortality from cardiovascular disease in the 
Americas – will the goal of a decline of “25% by 2025” be met?. 
PLoS One. 2015;10(10):e0141685.

5.   The determinants of health. World Health Organization. 
Published February 3, 2017. Accessed September 25, 2024. 
https://www.who.int/news-room/questions-and-answers/item/
determinants-of-health

6.   Gourgari E, Dabelea D, Rother K. Modifiable risk factors for 
cardiovascular disease in children with type 1 diabetes: can early 
intervention prevent future cardiovascular events?. Curr Diab 
Rep. 2017;17(12):134.

7.   World Bank country and lending groups. The World Bank. 
Accessed September 25, 2024. https://datahelpdesk.worldbank.
org/knowledgebase/articles/906519

8.   Noncommunicable Diseases (NCD) Country Profiles: Haiti. World 
Health Organization; 2018. Accessed September 25, 2024. https://
cdn.who.int/media/docs/default-source/country-profiles/ncds/
hti_en.pdf

9.   Noncommunicable Diseases (NCD) Country Profiles: Guyana. 
World Health Organization; 2018. Accessed September 25, 
2024. https://cdn.who.int/media/docs/default-source/country-
profiles/ncds/guy_en.pdf

10.  Noncommunicable Diseases (NCD) Country Profiles: Venezuela 
(Bolivarian Republic of). World Health Organization; 2018. 
Accessed September 25, 2024. https://cdn.who.int/media/docs/
default-source/country-profiles/ncds/ven_en.pdf

11.  Noncommunicable Diseases (NCD) Country Profiles: Canada. 
World Health Organization; 2018. Accessed September 25, 
2024. https://cdn.who.int/media/docs/default-source/country-
profiles/ncds/can_en.pdf

12.  Noncommunicable Diseases (NCD) Country Profiles: Chile. World 
Health Orgnization; 2018. Accessed September 25, 2024. https://
cdn.who.int/media/docs/default-source/country-profiles/ncds/
chl_en.pdf

13.  Noncommunicable Diseases (NCD) Country Profiles: Trinidad and 
Tobago. World Health Organization; 2018. Accessed September 
25, 2024. https://cdn.who.int/media/docs/default-source/
country-profiles/ncds/tto_en.pdf

14.  Wielgosz A, Jaffey J, Williams K, et al. Atlas of Cardiovascular 
Health in the Champlain Region, 2011. The Champlain 
Cardiovascular Disease Prevention Network; 2011. Accessed 
September 25, 2024. https://haloresearch.ca/wp-content/
uploads2/2011/07/ccpn-atlas.pdf

15.  Kreatsoulas C, Anand S. The impact of social determinants on 
cardiovascular disease. Can J Cardiol. 2010;26 (Suppl C):8C-13C.

16.  Heart disease facts. Centers for Disease Control and Prevention. 
Accessed September 25, 2024. https://www.cdc.gov/heart-
disease/data-research/facts-stats/index.html

17.  Senney GT, Steckel RH. Developmental origins of cardiovascular 
disease: understanding high mortality rates in the American 
South. Int J Environ Res Public Health. 2021;18(24):13192.

18.  Mental Health Action Plan 2013-2020. World Health Organization; 
2013. Accessed September 25, 2024. https://iris.who.int/
bitstream/handle/10665/89966/9789241506021_eng.pdf

19.  Strand B, Tverdal A. Can cardiovascular risk factors and lifestyle 
explain the educational inequalities in mortality from ischaemic 
heart disease and from other heart diseases? 26 year follow up 
of 50.000 Norwegian men and women. J Epidemiol Community 
Health. 2004;58(1)705-709.

20.  Kubota Y, Heiss G, MacLehose R, Roetker N, Folsom A. 
Association of educational attainment with lifetime risk of 
cardiovascular disease. JAMA Intern Med. 2017;177(8):1165.

21.  Education for All: Global Monitoring Report. UNESCO; 2012. 
Accessed September 25, 2024. https://unesdoc.unesco.org/
ark:/48223/pf0000217509

22.  Crimmins A, Balbus J, Gamble JL, et al. The Impacts of Climate 
Change on Human Health in the United States: A Scientific 
Assessment. US Global Change Research Program; 2016. Accessed 
September 25, 2024. http://dx.doi.org/10.7930/J0R49NQX

23.  De Blois J, Kjellstrom T, Agewall S, Ezekowitz J, Armstrong P, Atar 
D. The effects of climate change on cardiac health. Cardiology. 
2015;131(4):209-217.

24.  Ribeiro A, Duncan B, Brant L, Lotufo P, Mill J, Barreto S. 
Cardiovascular health in Brazil: trends and perspectives. 
Circulation. 2016;133(4):422-433.

25.  Cornwell E, Waite L. Social disconnectedness, perceived isolation, 
and health among older adults. J Health Soc Behav. 2009;50(1):31-48.

26.  Beyond Blue. Coronary Heart Disease, Anxiety and Depression. 
Heart Foundation; 2011. Accessed September 25, 2024. https://
www.heartfoundation.org.au/your-heart/mental-health-and-
heart-disease

27.  Uauy R, Kumanyika S, Seidell J, et al. WHO/FAO release 
independent expert report on diet and chronic disease. World 
Health Organization. Published March 3, 2003. Accessed 
September 25, 2024. https://www.who.int/news/item/03-03-
2003-who-fao-release-independent-expert-report-on-diet-and-
chronic-disease

28.  Anand SS, Hawkes C, de Souza RJ, et al. Food consumption and 
its impact on cardiovascular disease: importance of solutions 
focused on the globalized food system. J Am Coll Cardiol. 
2015;66(14):1590-1614.

29.  Social determinants of health and the prevention of health 
inequities. Australian Medical Association. March 5, 2007. 
Accessed September 25, 2024. https://ama.com.au/position-
statement/social-determinants-health-and-prevention-health-
inequities-2007

30.  Mukamal KJ. The effects of smoking and drinking on 
cardiovascular disease and risk factors. Alcohol Res Health. 
2006;29(3):199-202.

31. Simão AF, Précoma DB, de Andrade JP, Correa Filho H, 
Saraiva JFK, de Oliveira GMM; Brazilian Society of Cardiology. 
Cardiovascular prevention guideline of the Brazilian Society 
of Cardiology - executive summary. Arq Bras Cardiol. 
2014;102(5):420-431.

32.  Noncommunicable Diseases (NCD) Country Profiles: Saint Kitts 
and Nevis. World Health Organization; 2018. Accessed September 
25, 2024. https://cdn.who.int/media/docs/default-source/
country-profiles/ncds/kna_en.pdf

33.  IHME. Death rate from cardiovascular disease. Our World in 
Data. Published May 20, 2024. Accessed July 11, 2024. https://cdn.
who.int/media/docs/default-source/country-profiles/ncds/kna_
en.pdf?sfvrsn=79154496_36&download=true

http://www.amwajournal.org
https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1
https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1
https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-cardiovascular-conditions?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation
https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-cardiovascular-conditions?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation
https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-cardiovascular-conditions?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation
https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-cardiovascular-conditions?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation
https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-cardiovascular-conditions?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation
https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-cardiovascular-conditions?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation
https://iris.paho.org/bitstream/handle/10665.2/50952/9789275132265_eng.pdf?sequence=2&isAllowed=y
https://iris.paho.org/bitstream/handle/10665.2/50952/9789275132265_eng.pdf?sequence=2&isAllowed=y
https://iris.paho.org/bitstream/handle/10665.2/50952/9789275132265_eng.pdf?sequence=2&isAllowed=y
https://www.who.int/news-room/questions-and-answers/item/determinants-of-health
https://www.who.int/news-room/questions-and-answers/item/determinants-of-health
https://datahelpdesk.worldbank.org/knowledgebase/articles/906519
https://datahelpdesk.worldbank.org/knowledgebase/articles/906519
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/hti_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/hti_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/hti_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/guy_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/guy_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/ven_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/ven_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/can_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/can_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/chl_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/chl_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/chl_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/tto_en.pdf
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/tto_en.pdf
https://haloresearch.ca/wp-content/uploads2/2011/07/ccpn-atlas.pdf
https://haloresearch.ca/wp-content/uploads2/2011/07/ccpn-atlas.pdf
https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html
https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html
https://iris.who.int/bitstream/handle/10665/89966/9789241506021_eng.pdf
https://iris.who.int/bitstream/handle/10665/89966/9789241506021_eng.pdf
https://unesdoc.unesco.org/ark:/48223/pf0000217509
https://unesdoc.unesco.org/ark:/48223/pf0000217509
http://dx.doi.org/10.7930/J0R49NQX
https://www.heartfoundation.org.au/your-heart/mental-health-and-heart-disease
https://www.heartfoundation.org.au/your-heart/mental-health-and-heart-disease
https://www.heartfoundation.org.au/your-heart/mental-health-and-heart-disease
https://www.who.int/news/item/03-03-2003-who-fao-release-independent-expert-report-on-diet-and-chronic-disease
https://www.who.int/news/item/03-03-2003-who-fao-release-independent-expert-report-on-diet-and-chronic-disease
https://www.who.int/news/item/03-03-2003-who-fao-release-independent-expert-report-on-diet-and-chronic-disease
https://ama.com.au/position-statement/social-determinants-health-and-prevention-health-inequities-2007
https://ama.com.au/position-statement/social-determinants-health-and-prevention-health-inequities-2007
https://ama.com.au/position-statement/social-determinants-health-and-prevention-health-inequities-2007
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/kna_en.pdf 
https://cdn.who.int/media/docs/default-source/country-profiles/ncds/kna_en.pdf 
https://ourworldindata.org/grapher/cardiovascular-disease-death-rates
https://ourworldindata.org/grapher/cardiovascular-disease-death-rates



