A leading Canadian cardiovascular researcher is calling for a fundamental rethink of global heart health guidelines, warning that existing recommendations fail to account for social and economic disparities across different regions of the world.
Cardiovascular disease (CVD) remains the leading cause of death globally, accounting for the majority of annual fatalities. Alarmingly, 80 percent of these deaths occur in low- and middle-income countries, yet most heart-health recommendations continue to be shaped by research conducted in high-income nations.
Dr. Scott Lear, Professor of Health Sciences at Simon Fraser University and the Pfizer/Heart & Stroke Foundation Chair in Cardiovascular Prevention Research, is the lead author of a new global review that challenges the effectiveness of one-size-fits-all guidelines. Drawing on data from the ongoing Prospective Urban Rural Epidemiology (PURE) study, the review highlights the limitations of universal standards such as 75 minutes of exercise per week or five daily servings of fruits and vegetables.
“The world extends beyond high-income countries when it comes to heart health,” says Dr. Lear. “There’s a stark contrast between someone taking a leisurely walk in Vancouver and someone commuting on foot through the smog-filled streets of New Delhi, one of the world’s most polluted cities. We can’t pretend these are equivalent health behaviors.”
Understanding the “Causes Behind the Causes”
The review explores not only the direct risk factors for cardiovascular disease, but also the deeper, systemic influences—the “causes behind the causes.” These include the effects of education, income, work environments, pollution, social isolation, and healthcare access.
The PURE study, launched in 2002, provides the foundation for the research. It tracks more than 212,000 participants from 28 countries across five continents, with 87 percent of subjects living in low- or middle-income nations. Data is collected every three years through detailed questionnaires and physical measurements, offering insight into the complex realities affecting heart health worldwide.
According to Dr. Lear, even within a single city or region, vast disparities in living conditions can result in vastly different health outcomes. The study’s breadth allows researchers to examine how factors like urbanization, climate change, and public policy intersect with personal health.
Physical Activity: A Privilege, Not a Choice
While lack of physical activity is widely recognized as a risk factor for CVD, Dr. Lear’s review emphasizes that the context of such activity is often overlooked. In high-income countries, self-reported exercise levels are higher—even though 22 percent of participants report sitting for more than eight hours per day. In contrast, in low-income countries, only 4.4 percent sit that long, yet reported physical activity levels are lower overall.
The discrepancy lies in how physical activity is integrated into daily life. In wealthier nations, exercise is often a leisure activity. In lower-income regions, physical exertion is typically linked to transportation, domestic chores, or manual labor—tasks that are not always recognized in public health data.
Food Access and Economic Barriers
The review also underscores significant challenges in accessing nutritious food. While fruits, vegetables, legumes, and fish are essential for heart health, Dr. Lear found that their affordability and availability vary widely. In urban areas, these foods are generally more accessible. However, in many low-income countries, even farmers—those who grow the produce—cannot afford to eat it.
“This was a real eye-opener,” says Dr. Lear. “In some cases, reaching the recommended five servings of fruits and vegetables per day would consume up to 50 percent of a farming family’s income.”
Such findings expose the limitations of health advice that fails to consider economic and social realities. Dr. Lear argues that for heart health guidelines to be effective globally, they must be tailored to reflect these differences—not simply imposed as universal truths.
Rethinking Prevention
The study calls for a more inclusive, regionally responsive approach to cardiovascular disease prevention. That means shifting from generalized recommendations to ones that incorporate local infrastructure, food systems, income levels, and cultural practices.
“We need to stop pretending that the same advice works for everyone, everywhere,” Dr. Lear concludes. “Heart health is not just about individual behavior—it’s shaped by the environments we live in and the choices available to us.”
As the world continues to grapple with rising rates of cardiovascular disease, this research highlights the urgent need for global health guidelines that are grounded in equity and real-world context.
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