Among homeless individuals, cardiovascular disease remains one of the major causes of death due to challenges in predicting initial risk, limited access to health care, and difficulties in long-term management, according to a review published online on May 28, 2018 in the Journal of the American College of Cardiology. In the U.S., roughly 550,000 people are homeless on any given night, and an estimated 2.3 million to 3.5 million people experience homelessness over the course of a year. The median age of the homeless population is 50 years, approximately 60 percent are male and 39 percent are African-American. These demographic groups experience high cardiovascular disease mortality rates, highlighting the need for proper prevention and treatment. While the prevalence of hypertension and diabetes among homeless individuals is similar to that of the general population, it often goes untreated, leading to worse blood pressure and blood sugar control. Smoking remains the largest contributor to cardiovascular disease mortality in homeless populations, with an estimated 60 percent of ischemic heart disease deaths attributable to tobacco. Although, according to the review, most homeless individuals have a desire to quit smoking, quit rates are only one-fifth the national average. Homeless populations are more likely to drink heavily and have a history of cocaine use, which have been linked to congestive heart failure, atherosclerosis, heart attack, and sudden cardiac death. Twenty-five percent of homeless people have a chronic mental illness, contributing to cardiovascular disease risk and complicating diagnoses by impacting motivation to seek care.
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