Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events

Abstract

Background Although there is research on the impact of social determinants of health (SDOHs) on cardiovascular health, most existing evidence is based on individual SDOH components. We evaluated the impact of cumulative SDOH burden on cardiovascular risk factors, subclinical atherosclerosis, and incident cardiovascular disease events. Methods and Results We included 6479 participants from the MESA (Multi‐Ethnic Study of Atherosclerosis). A weighted aggregate SDOH score representing the cumulative number of unfavorable SDOHs, identified from 14 components across 5 domains (economic stability, neighborhood and physical environment, community and social context, education, and health care system access) was calculated and divided into quartiles (quartile 4 being the least favorable). The impact of cumulative SDOH burden on cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, and obesity), systemic inflammation, subclinical atherosclerosis, and incident cardiovascular disease was evaluated. Increasing social disadvantage was associated with increased odds of all cardiovascular risk factors except dyslipidemia. Smoking was the risk factor most strongly associated with worse SDOH (odds ratio [OR], 2.67 for quartile 4 versus quartile 1 [95% CI, 2.13–3.34]). Participants within SDOH quartile 4 had 33% higher odds of increased high‐sensitivity C‐reactive protein (OR, 1.33 [95% CI, 1.11–1.60]) and 31% higher risk of all cardiovascular disease (hazard ratio, 1.31 [95% CI, 1.03–1.67]), yet no greater burden of subclinical atherosclerosis (OR, 1.01 [95% CI, 0.79–1.29]), when compared with those in quartile 1. Conclusions Increasing social disadvantage was associated with more prevalent cardiovascular risk factors, inflammation, and incident cardiovascular disease. These findings call for better identification of SDOHs in clinical practice and stronger measures to mitigate the higher SDOH burden among the socially disadvantaged to improve cardiovascular outcomes.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…56 A recent publication from the MESA study found that greater social disadvantage as measured by an aggregated score across 5 social determinants of health domains was associated with greater odds of unfavorable CVH risk factors, including hypertension, diabetes, smoking, and obesity, and higher risk of CVD, consistent with the notion of social determinants of health as a foundational factor for CVH. 57…”

Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review

“…13 A study with a nationally representative sample of US adults found that NH Black (29.2%) and Hispanic adults (43%) were more socially disadvantaged, defined as higher SDoH index scores than NH White adults (19.8%). 14 This increase in social disadvantage was associated with significantly higher odds of CVD risk factors (hypertension, 1.17 [0. 99-1.38]; diabetes, 1.65 [1.32-2.06]; smoking, 2.68 [2.13-3.37]; obesity, 1.25 [1.06-1.47]) and events (incident atherosclerotic, 1.36 [1.11-1.66]).…”

Epigenetics of Early Cardiometabolic Disease: Mechanisms and Precision Medicine

“…Social determinants of health, including socioeconomic status (SES), social support, and psychological stress, have been identified as risk factors for CVD. [14][15][16][17][18] In recent years, epigenetic modifications, such as DNA methylation (DNAm), have emerged as potential mechanisms linking social components to cardiovascular health. 19,20 Some investigators have focused on one of those Social determinants of health; however, it is essential to recognize that these SDH are interconnected and can have a cascading effect on health outcomes.…”