TORONTO - A new Canadian study is shedding light on what its authors call "the causes of the causes" of heart disease around the globe.
The risk factors or causes of heart disease have been well documented — things like smoking, being overweight, Type 2 diabetes and high cholesterol.
But this work, done by researchers from McMaster University in Hamilton, is trying to tease out why individuals and societies around the world have those risk factors.
The information is being presented at the European Society of Cardiology Congress in Munich, Germany.
The researchers gathered data from nearly 154,000 people from 628 communities in 17 countries.
The team hopes the findings will be used to help governments design public health programs that fit their individual situations.
Many of the findings don't come as a surprise. People in poorer countries expend more energy, and have less varied diets that rely heavily on carbohydrates.
People in wealthier countries eat diets that contain more fruits and vegetables, proteins and total fats than those from poorer countries. They're also quitting smoking at higher rates than those from poorer countries. But they are less physically active.
SEE: 12 foods that could help lower cholesterol. Story continues below:
When it comes to heart health, we can't stop singing the praises of oatmeal. But other grains, like barley, are also healthy picks. Both are packed with fiber -- which helps keep you full for longer so you reach for the chips less. But fiber does more than just keep you slim. Soluble fiber, the kind that the body can digest, seems to reduce the amount of cholesterol the body absorbs from the intestines, lowering total cholesterol and LDL or "bad" cholesterol in the process. Flickr photo by Mr. T in DC
You might think that fatty fish could be detrimental to your ticker, but the right seafood can lower cholesterol for a couple of reasons. First, eating more fish might mean that you're replacing meat in your diet, and meat contains more LDL-boosting saturated fats. Second, fish like salmon, sardines and albacore tuna are high in omega-3 fatty acids, which have been shown to lower triglycerides. Flickr photo by DesheBoard
Toss them in salads, sprinkle them on oatmeal or snack on them by the perfectly-portioned handful. Just about any variety of nut can lower total cholesterol, LDL and triglyceride levels, according to a 2010 analysis of data from 25 studies on nut consumption. Flickr photo by tvol
Swapping the saturated fats found in butter for the unsaturated ones in oils is a good idea for both your waistline and your heart. Doing so can help reduce total cholesterol, but using olive oil in particular may also increase HDL, or "good" cholesterol.
A medium-sized apple contains about 4 grams of LDL-lowering soluble fiber, or about 17 percent of your recommended daily intake. An apple a day can keep the heart doctor away! Flickr photo by manitou2121
Strawberries are rich in pectin, a type of soluble fiber that can lower LDL. One study found that supplementing a heart-healthy diet with strawberries had similar results to adding oats to a heart-healthy diet -- and tasted better, too! Flickr photo by Plinkk
You'll also find pectin in oranges, grapefruits and other citrus fruits. And adding more fiber to your diet can lower blood pressure and reduce inflammation, both of which help your heart. Flickr photo by little blue hen
Kidney, navy, garbanzos -- your favorite beans and lentils are all great sources of soluble fiber, which helps keep you full and can reduce cholesterol. A 2008 study from Arizona State University found that people who ate a half-cup of beans a day (at the time, the recommended amount according to the U.S. Dietary Guidelines for Americans) over a 24-week period lowered their cholesterol by 8 percent. If you eat around 2,000 to 2,500 calories a day, aim for a cup and a half to two cups of beans a week. Flickr photo by tomcensani
Like with fish, if you're eating soy, chances are you're eating less meat, which is higher in saturated fat and cholesterol. Soy is unique in the fact that it's a great source of protein, and yet it's free of any animal products, so it's also cholesterol free. However, it's not the cholesterol-busting superpower it was once touted to be. A 2010 study found that eating soy can result in a moderate 8 to 10 percent decrease in total cholesterol. Flickr photo by Rooey202
You probably already know that a little alcohol -- in moderation of course -- is good for you. Part of the reason why? A 2000 study established that occasion clinking of glasses can raise HDL, or "good" cholesterol. Red wine may be particularly beneficial, since it's rich in antioxidants, which may lower LDL levels. Flickr photo by Dinner Series
Like olive oil, avocados are rich in cholesterol-lowering unsaturated fats. Monounsaturated fats, the ones found in the creamy green fruit, may lower LDL and raise HDL -- but probably only if you are replacing unhealthier dietary fats with these heart-healthy ones. Flickr photo by annethelibrarian
The miracle drink has been linked to everything from fighting cancer to keeping the mind sharp, but few studies have truly explained why green tea is such a powerful health elixir and just how much of it you'd need to drink to see results. While it does appear to lower "bad" cholesterol, it's only a slight reduction -- and you'd probably have to drink quite a few mugs full to see a difference. Chugging green tea isn't a good idea for everyone; it can interfere with some medications. Flickr photo by Qfamily
A co-investigator of the ongoing study says its goal is to provide hard data so that policy formation doesn't have to rely on supposition.
"We have lots of data on mostly white, Caucasian adults living in North America and Europe. So you might say: What's new about the information from that perspective?" says Dr. Sonia Anand, who is a professor of medicine at McMaster.
"But the global projections of where the greatest number of cardiovascular deaths will occur are that 80 per cent of the burden of cardiovascular disease will be occurring in low-income and middle-income countries in the year 2020. So we need to understand what the trends are in those regions in order to come up with prevention programs, policy changes, etc., to prevent the epidemic in those regions."
Trying to persuade low- and middle-income countries to act based on data from elsewhere — for instance, saying "Your people are getting richer, so you're going to start to see these problems" — generally results in push back, says Anand. The response is: "Your information is not directly applicable to us."
"Now the beauty of this study is we have data from so many countries and communities that the local community and the country can use this information for health policy and planning," Anand says.
The study looked at a range of countries selected to represent income classifications delineated by the World Bank. Canada, Sweden and United Arab Emirates represent high income countries. Upper middle income countries include Argentina, Brazil, Chile, Poland, Turkey, South Africa and Malaysia. China, Colombia and Iran represent lower middle income countries. And India, Bangladesh, Pakistan and Zimbabwe make up the lower income nations.
The study shows patterns that are a cause of concern. As a country's wealth grows, its people start to acquire the poor health habits seen in wealthier countries.
"We used to think — and there's strong evidence showing that as you become more wealthy, your water supply improves, the food contamination decreases, so acute infectious disease improve with acquisition of wealth. But the risk factors for chronic diseases increase," Anand says.
"Although we all think that acquisition of wealth is good for a person, and actually improves their health, what we're seeing with those transitions from rural to urban in low income countries is that ... the diet starts to change in adverse ways. That people go from high physical activity jobs to more sedentary jobs."
"If we look at processed meats, we look at soft drink consumption, and fried foods, etc., they all go up in consumption when people gain wealth."