Social and structural determinants of health have gained prominence regarding their influence on the cardiovascular health of the population. In recent publications, the American Heart Association has directed its attention to inequalities in healthcare, mediated by social (such as income, education, safety, place of residence, and neighborhood) and structural determinants (access to healthcare, basic sanitation, clean air, healthy environment), and its deleterious impacts on cardiovascular health.^– It discusses how to implement actions with the potential to eliminate these inequalities in health care that adversely affect the cardiovascular health of marginalized populations. In addition, it addresses strategies to achieve cardiovascular health for all in an equitable way, with a focus on increasing the average population longevity, given that cardiovascular diseases continue to be the main cause of death worldwide, including in Brazil, led by ischemic heart disease..

In this direction, the cross-sectional study by Cerci et al. contributes to the analysis of whether a public environment conducive to walking (walkability) in the neighborhood mediates the potential relationship between income level and ischemic heart disease (IHD) of residents of a city with 1,773,718 inhabitants, located in a middle-income country. The authors analyzed 26,415 individuals from the city of Curitiba/Brazil, in the period between 2010 and 2017, 96.5% of whom were covered by a private health plan and diagnosed with IHD through myocardial perfusion imaging using computed tomography with single photon emission. (SPECT-MPI).

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