TY - JOUR
T1 - Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events
AU - Acquah, Isaac
AU - Hagan, Kobina
AU - Javed, Zulqarnain
AU - Taha, Mohamad B.
AU - Valero-Elizondo, Javier
AU - Nwana, Nwabunie
AU - Yahya, Tamer
AU - Sharma, Garima
AU - Gulati, Martha
AU - Hammoud, Aziz
AU - Shapiro, Michael D.
AU - Blankstein, Ron
AU - Blaha, Michael J.
AU - Cainzos-Achirica, Miguel
AU - Nasir, Khurram
N1 - Publisher Copyright:
© 2023 The Authors.
PY - 2023/3/21
Y1 - 2023/3/21
N2 - 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 inflam-mation, 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.
AB - 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 inflam-mation, 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.
KW - cardiovascular disease
KW - disparities
KW - equity
KW - risk factors
KW - social determinants of health
KW - Social Determinants of Health
KW - Humans
KW - Risk Factors
KW - Atherosclerosis
KW - Inflammation
KW - Heart Disease Risk Factors
KW - Cardiovascular Diseases/diagnosis
UR - http://www.scopus.com/inward/record.url?scp=85150751156&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150751156&partnerID=8YFLogxK
U2 - 10.1161/JAHA.122.025581
DO - 10.1161/JAHA.122.025581
M3 - Article
C2 - 36926956
AN - SCOPUS:85150751156
SN - 2047-9980
VL - 12
SP - e025581
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 6
M1 - e025581
ER -