A landmark study that examined the influence of geography on heart disease patients has found where you live makes a big difference.

"When you have 33 million people spread over 6,000 miles, you can't have the same facility in every place," said Dr. Jack Tu, Canadian Cardiovascular Outcomes Research Team (CCORT) Atlas Editor and Senior Scientist at the Institute for Clinical Evaluative Sciences.

"People in rural areas are clearly disadvantaged, mostly by the length of time people have to wait," said Dr. Andreas Wielgosz of the Heart and Stroke Foundation.

The CCORT released the collective findings of the Canadian Cardiovascular Atlas on Tuesday, with one conclusion being that people out West are more heart-healthy.

"In general, what we found in Canada is that there's an

'East to West gradient' in terms of the death rate from heart disease -- that you're more likely to die in Eastern Canada as opposed to Western Canada," Tu said Wednesday morning, appearing on CTV's Canada AM.

The so-called Atlas is the largest report of its kind to examine the effects of geography on the risk factors, treatments, and outcomes of heart disease for the more than 1.2 million Canadians suffering from the condition.

Atlantic Canadians were most at risk from heart disease, along with people living in rural Ontario.

Provincial cardiovascular disease (CVD) mortality rates ranged from a high of 320.6 out of every 100,000 in Newfoundland and Labrador to a low of 196.9 out of every 100,000 in the Northwest Territories.

Most provinces had a cardiovascular mortality rate higher than the national average except for Saskatchewan, British Columbia, Ontario, the Northwest Territories and Nunavut.

"B.C. has traditionally had the toughest anti-smoking legislation in Canada and the highest cigarette prices. And now other provinces are catching up," Tu said Wednesday.

The reverse is true in Atlantic Canada.

"The risk factor burden in Atlantic Canada is much more than it is in the western provinces, so I'm talking bout obesity, smoking, diabetes and a sedentary lifestyle," said Dr. Blair O'Neill, head of cardiology at the Queen Elizabeth II hospital in Halifax.

Tu said that the regions that have the highest heart disease mortality rates are those with the highest incidence of traditional cardiac risk factors.

Those factors include "really high smoking rates, really high obesity rates, higher rates of diabetes and hypertension," Tu said.

"Poverty is also an important factor when it comes to heart disease. In general, the regions that have higher incidence of risk factors also tend to be poorer on average."

Other notable stats in the report:

• Across all provinces, men had a higher mortality rate than women;
• The overall Canadian mortality rate was 245.8 out of 100,000;
• For men, it was 316.7 out of 100,000; and
• For women, it was 192.7 of 100,000.

The study found broader determinants of health, such as employment status and education levels, helped explain regional disparities.

"Given that CVD is the leading cause of death in Canada, we believe that additional investments in understanding these determinants are vital towards improving the cardiac health status of Canada and could potentially yield large health benefits to Canadians across the country," the study said.

The study was based on data obtained from Statistics Canada for 1995 to 1997 while data on health region characteristics was taken from the 2000/2001 Canadian Community Health Survey, and the 1996 Canadian Census and the Labour Force Survey.

Though Western Canada had lower rates of heart disease, the findings suggested a contradiction.

British Columbians were the least likely to receive evidence-based therapies such as beta-blockers following hospital admission for a heart attack.

"The Atlas findings suggest there are opportunities for all provinces and regions of Canada to improve the health profiles of their citizens and the outcomes of those who suffer from heart disease," Tu said.

The findings also reveal that cardiovascular disease is still the leading cause of death in Canada, responsible for 37 per cent of all deaths in the country.

Procedures vary

Furthermore, there is significant variation in the rates of cardiac procedures and cardiac drug spending across Canada that do not appear to reflect differences in clinical need, but other factors such as policy differences, physician practice styles, and possibly patient preferences.

The Canadian Cardiovascular Outcomes Research Team issued several recommendations based on the findings, which include:

The implementation of a national cardiovascular surveillance system to permit studies such as this one;

Funding should be made available to improve the quality and quantity of clinical databases available to study trends in health system performance; and

Collaboration between federal and provincial governments to ensure all Canadians have similar levels of access to current cardiovascular treatments.

"The Canadian Institutes of Health Research (CIHR) is helping to build teams like CCORT to address current gaps in the system and improve access to health care," said Dr. Peter Liu, Scientific Director of CIHR's Institute of Circulatory and Respiratory Health.

"With this type of strategy we can continue to decrease death due to cardiovascular disease across the country."

The study concluded lifestyle is still the biggest controllable factor, with researchers saying 30 to 50 per cent of all heart attacks could be prevented if people stopped smoking, ate properly and exercised.

With a report from CTV's Rosemary Thompson