Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events
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 inc...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.025581 |
| _version_ | 1797866377125560320 |
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| author | Isaac Acquah Kobina Hagan Zulqarnain Javed Mohamad B. Taha Javier Valero‐Elizondo Nwabunie Nwana Tamer Yahya Garima Sharma Martha Gulati Aziz Hammoud Michael D. Shapiro Ron Blankstein Michael J. Blaha Miguel Cainzos‐Achirica Khurram Nasir |
| author_facet | Isaac Acquah Kobina Hagan Zulqarnain Javed Mohamad B. Taha Javier Valero‐Elizondo Nwabunie Nwana Tamer Yahya Garima Sharma Martha Gulati Aziz Hammoud Michael D. Shapiro Ron Blankstein Michael J. Blaha Miguel Cainzos‐Achirica Khurram Nasir |
| author_sort | Isaac Acquah |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T23:23:11Z |
| format | Article |
| id | doaj.art-9dcb99ef1b6c4a7fa1a4256e59ecab8a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T23:23:11Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-9dcb99ef1b6c4a7fa1a4256e59ecab8a2023-03-21T11:45:26ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-03-0112610.1161/JAHA.122.025581Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular EventsIsaac Acquah0Kobina Hagan1Zulqarnain Javed2Mohamad B. Taha3Javier Valero‐Elizondo4Nwabunie Nwana5Tamer Yahya6Garima Sharma7Martha Gulati8Aziz Hammoud9Michael D. Shapiro10Ron Blankstein11Michael J. Blaha12Miguel Cainzos‐Achirica13Khurram Nasir14Center for Outcomes Research Houston Methodist Houston TXCenter for Outcomes Research Houston Methodist Houston TXDivision of Health Disparities and Equity Research Center for Outcomes Research, Houston Methodist Houston TXDivision of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TXCenter for Outcomes Research Houston Methodist Houston TXCenter for Outcomes Research Houston Methodist Houston TXDivision of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TXCiccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MDDivision of Cardiology University of Arizona (Phoenix) Phoenix AZWake Forest School of Medicine Winston Salem NCSection of Cardiovascular Medicine Wake Forest School of Medicine Winston Salem NCCardiovascular Imaging Program, Department of Medicine and Radiology Brigham and Women’s Hospital Boston MACiccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MDCenter for Outcomes Research Houston Methodist Houston TXCenter for Outcomes Research Houston Methodist Houston TXBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.122.025581cardiovascular diseasedisparitiesequityrisk factorssocial determinants of health |
| spellingShingle | Isaac Acquah Kobina Hagan Zulqarnain Javed Mohamad B. Taha Javier Valero‐Elizondo Nwabunie Nwana Tamer Yahya Garima Sharma Martha Gulati Aziz Hammoud Michael D. Shapiro Ron Blankstein Michael J. Blaha Miguel Cainzos‐Achirica Khurram Nasir Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular disease disparities equity risk factors social determinants of health |
| title | Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events |
| title_full | Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events |
| title_fullStr | Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events |
| title_full_unstemmed | Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events |
| title_short | Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events |
| title_sort | social determinants of cardiovascular risk subclinical cardiovascular disease and cardiovascular events |
| topic | cardiovascular disease disparities equity risk factors social determinants of health |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.025581 |
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