Universal Heart Health Advice Ignores Realities in Low-Income Countries: Study Finds

Global recommendations for heart health may not apply universally, especially in low- and middle-income countries, according to a new review published in the British Medical Journal Global Health. The study, led by Scott Lear, a cardiovascular disease expert from Simon Fraser University, concludes that one-size-fits-all guidelines often ignore the broader social and environmental contexts that shape heart disease risk. It calls for health policies that are more sensitive to local realities in order to be truly effective in preventing cardiovascular disease (CVD) worldwide.

Cardiovascular disease is the leading cause of death globally, with 80 percent of cases occurring in low- and middle-income countries. Yet international guidelines—such as engaging in 75 minutes of exercise weekly or consuming five servings of fruits and vegetables daily—are largely based on studies from high-income nations, says Lear, who is also the Pfizer/Heart & Stroke Foundation Chair in Cardiovascular Prevention Research.

“The world extends beyond high-income countries when we think about universal recommendations like 75 minutes of exercise each week or getting five servings of fruit and vegetables every day,” says Lear.

“There’s a stark contrast between a daily sidewalk stroll in Vancouver's West End and walking to work in New Delhi, the world’s most polluted city, where many people cannot afford to drive and public transit is lacking,” he adds. “We cannot assume that life is the same everywhere. The environments in which people live and the kind of work they do make a huge difference to their health.”

Drawing on data from the Prospective Urban Rural Epidemiology (PURE) study—which has tracked over 212,000 people in 28 countries since 2002—the review highlights how physical activity and diet vary dramatically by region and income. In many low-income settings, physical exertion comes from necessity, not leisure, and farmers often can't afford to eat the produce they grow. “For many of these farmers, getting the recommended minimum of five servings of fruits and vegetables a day would eat up 50 percent of their household income,” Lear notes.

The study urges global health leaders to rethink prevention strategies, tailoring them to the lived realities of communities most affected by cardiovascular disease.

Reference: Scott A Lear, Martin McKee, Perry Hystad, Blake Byron Walker, Adrianna Murphy, Michael Brauer, Marjan Walli-Attaei, Annika Rosengren, Sumathy Rangarajan, Clara K Chow, Salim Yusuf, Social factors, health policy, and environment: implications for cardiovascular disease across the globe, European Heart Journal, 2025;, ehaf212, https://doi.org/10.1093/eurheartj/ehaf212