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Heart and Home: A Disease Connection? The old saying "home is where the heart is" usually refers to our emotional attachment to the place we live. Recent research suggests, however, that home may also be the place where heart illness is. Genetic Make-up or Lifestyle? Scientists are now looking beyond issues of genetic make-up or lifestyle to see whether other factors are significantly correlated to the incidence of coronary problems. A research team, lead by Dr. A. Diez Roux, recently completed a study in which rates of coronary-related conditions in four different geographical regions of the United States were compared. Researchers took into account the effects of employment, income and level of education. Diez Roux and her associates selected four distinct communities: Jackson MS in the south, suburban Minneapolis MN in the north, Washington County MD in the northern mid-Atlantic region, and Forsyth County, NC in the southern mid-Atlantic area. These locations cover the spectrum from urban to rural, and from affluent to poor, and they also represent Caucasian and African American communities. The timeline for the initial data gathering and follow-ups was an average of 9.1 years and included over 13,000 people. Socioeconomic Factors While socioeconomic factors have long been documented as having a bearing on the incidence of heart problems, the research team chose to focus instead on the characteristics of the neighborhoods themselves to see whether, in fact, a cause-and-effect relationship existed between those characteristics and heart disease. When the data were analyzed the researchers found that living in neighborhoods classified as "disadvantaged" could be related to an increased risk of developing heart problems. The important aspect of this finding was that individual characteristics of the subjects were controlled so that the relationship of neighborhood to risk could be viewed independently. Some of the factors identified by Diez Roux as contributors to increased risk are obvious. The amount of tobacco and alcohol advertising and the limited availability of healthy food selections are two examples of these elements. Other variables were subtler: a lack of recreational facilities and public spaces appeared to limit the amount and types of exercise undertaken. Many of the disadvantaged areas also have high levels of noise and the types of negative social behaviors that add to or create an atmosphere of chronic stress. All of these factors tend to result in a higher likelihood of coronary incidents. This study clearly shows that future health initiatives must take into account both personal and community factors in developing prevention programs. Given the economic realities that confront society as a whole, clinical findings of this sort will become tools in both the diagnosis and treatment of heart disease. Resource Diez Roux, A., et. Al. (2001, July 12) Neighborhood of residence and incidence of coronary heart disease. New England Journal of Medicine, 345(2), 99-106.

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