Cardiovascular Disease

Cardiovascular Risk and Homelessness

Adults who experience homelessness die from heart disease at a much higher rate than those in the general population. One study found that men experiencing homelessness, aged 45 to 64, were between 40 and 50 percent more likely to die from heart disease than their counterparts (Lee, 2005). The following risk factors were identified by these same authors:

  • poor glycemic control among those with diabetes, even when receiving oral hypoglycemic agents
  • high prevalence of heavy cigarette smoking
  • poor hypertension control (high incidence of inadequate diagnosis and/or treatment)
  • poor hyperlipidemia control (high incidence of inadequate diagnosis and/or treatment)
  • increased incidence of elevated homocysteine levels believed to be resulting from high rates of smoking and prevalence of inadequate nutrition (B vitamins and folate)

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Case Report

Practitioners serving homeless adults report that treatment of heart disease in these patients often requires earlier hospitalization than for domiciled patients due to their greater difficulty controlling sodium and fat intake and obtaining bed rest. When pharmacotherapy is indicated, many homeless people resist treatment or have extreme difficulty adhering to any medical regimen—particularly those who suffer from psychiatric illnesses, mental retardation, and/or substance use disorders. Non-adherence is one of the most difficult challenges that clinicians face in caring for displaced individuals, as the Clinicians’ Network case report Hypertension & Homelessness: What Interferes with Treatment (2006) vividly illustrates.

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