Return to the city? Living in the country could be the worst thing for your heart

BETHESDA, Md. — The COVID pandemic saw people moving out of the cities when work-from-home became the new normal in society. Now, scientists are giving the public a reason to move back to the concrete jungle. Researchers with the National Institute of Health say there’s a 19-percent higher risk of experiencing heart failure when you reside in a rural area compared to an urban setting. The risk is even higher among Black men living in the countryside. The study is one of the first to establish a connection between rural settings and developing heart failure.

“We did not expect to find a difference of this magnitude in heart failure among rural communities compared to urban communities, especially among rural-dwelling Black men,” says Véronique L. Roger, MD, MPH, a scientist at the Epidemiology and Community Health Branch in the National Heart, Lung, and Blood Institute’s (NHLBI) Division of Intramural Research, in a media release. “This study makes it clear that we need tools or interventions specifically designed to prevent heart failure in rural populations, particularly among Black men living in these areas.”

Heart failure occurs when the heart fails to pump enough blood for the body. About 6.2 million American adults have this chronic condition, with few treatment options to explore once it develops. The findings suggest preventative measures for heart health is even more important in rural America.

“It is much easier to prevent heart failure than to reduce its mortality once you have it,” adds study author Sarah Turecamo, a medical school at NYU Grossman School of Medicine.

Following a heart-healthy lifestyle is key to reducing your risk of heart failure. This includes managing your stress levels, exercising, and staying away from foods filled with trans and saturated fat that would increase your blood pressure. High blood pressure is one of the biggest contributors to heart failure, and the study authors note that Black men disproportionally have high hypertension levels. Checking your blood pressure regularly can help you spot signs that could lead to heart failure.

Black men and women in rural areas both at risk of heart failure

The researchers tracked the health of 27,115 adults living in the southeastern United States for 13 years. Nearly 69 percent of Black adults were from community health centers that care for medically underserved groups. About 20 percent lived in the countryside while the rest were in cities. The team compared the rate of first-time heart failure among rural and urban dwellers in 12 states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia).

Living in rural America was linked to a 19-percent higher risk for heart failure among women and Black men than city folk. Black men in rural areas had the highest risk of newly-onset heart failure at 34 percent. Black women did not fare any better. Those living in rural areas had an 18-percent increased risk for heart failure than Black women living in urban sites. There was no association between rural living and heart failure risk for White men.

The study did not explain why living in the country affects your heart health, but the researchers have proposed several explanations. Despite a cheaper cost of living, rural areas may not have enough doctors or healthcare services to help sick residents. There are also considerably less grocery stores that offer healthy food options and structural racism that could block access to proper medical care.

“Finding an association between living in rural areas and an increased incidence of heart failure is an important advance, especially given its implications for helping to address geographic-, gender-, and race-based disparities,” says David Goff, MD, PhD, director of NHLBI’s Division of Cardiovascular Sciences. “We look forward to future studies testing interventions to prevent heart failure in rural populations as we continue to fight heart disease, the leading cause of death in the U.S.”

The study is published in JAMA Cardiology.

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About the Author

Jocelyn Solis-Moreira

Jocelyn is a New York-based science journalist whose work has appeared in Discover Magazine, Health, and Live Science, among other publications. She holds a Master’s of Science in Psychology with a concentration in behavioral neuroscience and a Bachelor’s of Science in integrative neuroscience from Binghamton University. Jocelyn has reported on several medical and science topics ranging from coronavirus news to the latest findings in women’s health.

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