Social Environment as a Precursor to Coronary Artery Disease in a Small, Resource-Limited Country

Abstract

Background: Coronary artery disease has been the most prevalent chronic disease over the last two decades. In Trinidad and Tobago—a small, high-income, resource-limited country the median age of presentation of, and premature death from, acute myocardial infarction is more than 12 years earlier to that in high-income, developed countries. This may be attributed to the increased risk of coronary artery disease that stem from the presence of precursors in the social environment. Objective: We aimed to explore the association between “social environment” and coronary artery disease in Trinidad and Tobago. Methods: This is a descriptive ecological study that assessed secondary data. Data were collected from multiple search engines and websites. Data on Trinidad and Tobago’s social environment were also accessed from the World Databank and the Central Intelligence Agency fact book and analyzed. Results: Coronary artery disease was fueled by personal choices that were influenced by the social environment (“fast food” outlets, inadequate sporting facilities, increased use of activity-saving tools [vehicles, phones, and online activities], smoking and alcohol accessibility, and social stressors [murder, family disputes, divorce, child abuse, kidnapping, and rape]). Food imports, as a percentage of merchandise imports, were at 11.42% (2015); the level of physical activity was low (<600 MET-minutes per week; 38 in 2016), and social stressors were high. Conclusion: The social environment has encouraged a “cardiotoxic” or “atherogenic” environment influencing behavior, eventually resulting in a continued high risk of coronary artery disease, presenting at a younger age.