TY - JOUR
T1 - Social Determinants of Health and Cardiovascular Disease
T2 - Current State and Future Directions Towards Healthcare Equity
AU - Jilani, Mohammad Hashim
AU - Javed, Zulqarnain
AU - Yahya, Tamer
AU - Valero-Elizondo, Javier
AU - Khan, Safi U.
AU - Kash, Bita
AU - Blankstein, Ron
AU - Virani, Salim S.
AU - Blaha, Michael J.
AU - Dubey, Prachi
AU - Hyder, Adnan A.
AU - Vahidy, Farhaan S.
AU - Cainzos-Achirica, Miguel
AU - Nasir, Khurram
N1 - Funding Information:
None Dr Virani reports grants from the Department of Veterans Affairs, World Heart Federation, and Tahir and Jooma Family and honorarium from the American College of Cardiology (Associate Editor for Innovations, acc.org) and serves as a member of the steering committee for the PALM (Patient and Provider Assessment of Lipid Management) Registry at Duke Clinical Research Institute (no financial remuneration). Dr. Nasir reports being on advisory board for Amgen, Esperion, and Novartis and is supported by Katz Academy of Translational Science. Dr. Blaha reports grants from NIH, FDA, AHA, and Aetna; grants and personal fees from Amgen and Novo Nordisk; and personal fees from Bayer, Novartis, Sanofi, Regeneron, Akcea, 89Bio, Kowa, and Inozyme, outside the submitted work. The other authors had no disclosures to report. This article does not contain any studies with human or animal subjects performed by any of the authors.
Funding Information:
Dr Virani reports grants from the Department of Veterans Affairs, World Heart Federation, and Tahir and Jooma Family and honorarium from the American College of Cardiology (Associate Editor for Innovations, acc.org ) and serves as a member of the steering committee for the PALM (Patient and Provider Assessment of Lipid Management) Registry at Duke Clinical Research Institute (no financial remuneration).
Funding Information:
Dr. Nasir reports being on advisory board for Amgen, Esperion, and Novartis and is supported by Katz Academy of Translational Science.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021/9
Y1 - 2021/9
N2 - Purpose of Review: We sought to examine the role of social and environmental conditions that determine an individual’s behaviors and risk of disease—collectively known as social determinants of health (SDOH)—in shaping cardiovascular (CV) health of the population and giving rise to disparities in risk factors, outcomes, and clinical care for cardiovascular disease (CVD), the leading cause of death in the United States (US). Recent Findings: Traditional CV risk factors have been extensively targeted in existing CVD prevention and management paradigms, often with little attention to SDOH. Limited evidence suggests an association between individual SDOH (e.g., income, education) and CVD. However, inequities in CVD care, risk factors, and outcomes have not been studied using a broad SDOH framework. Summary: We examined existing evidence of the association between SDOH—organized into 6 domains, including economic stability, education, food, neighborhood and physical environment, healthcare system, and community and social context—and CVD. Greater social adversity, defined by adverse SDOH, was linked to higher burden of CVD risk factors and poor outcomes, such as stroke, myocardial infarction (MI), coronary heart disease, heart failure, and mortality. Conversely, favorable social conditions had protective effects on CVD. Upstream SDOH interact across domains to produce cumulative downstream effects on CV health, via multiple physiologic and behavioral pathways. SDOH are major drivers of sociodemographic disparities in CVD, with a disproportionate impact on socially disadvantaged populations. Efforts to achieve health equity should take into account the structural, institutional, and environmental barriers to optimum CV health in marginalized populations. In this review, we highlight major knowledge gaps for each SDOH domain and propose a set of actionable recommendations to inform CVD care, ensure equitable distribution of healthcare resources, and reduce observed disparities.
AB - Purpose of Review: We sought to examine the role of social and environmental conditions that determine an individual’s behaviors and risk of disease—collectively known as social determinants of health (SDOH)—in shaping cardiovascular (CV) health of the population and giving rise to disparities in risk factors, outcomes, and clinical care for cardiovascular disease (CVD), the leading cause of death in the United States (US). Recent Findings: Traditional CV risk factors have been extensively targeted in existing CVD prevention and management paradigms, often with little attention to SDOH. Limited evidence suggests an association between individual SDOH (e.g., income, education) and CVD. However, inequities in CVD care, risk factors, and outcomes have not been studied using a broad SDOH framework. Summary: We examined existing evidence of the association between SDOH—organized into 6 domains, including economic stability, education, food, neighborhood and physical environment, healthcare system, and community and social context—and CVD. Greater social adversity, defined by adverse SDOH, was linked to higher burden of CVD risk factors and poor outcomes, such as stroke, myocardial infarction (MI), coronary heart disease, heart failure, and mortality. Conversely, favorable social conditions had protective effects on CVD. Upstream SDOH interact across domains to produce cumulative downstream effects on CV health, via multiple physiologic and behavioral pathways. SDOH are major drivers of sociodemographic disparities in CVD, with a disproportionate impact on socially disadvantaged populations. Efforts to achieve health equity should take into account the structural, institutional, and environmental barriers to optimum CV health in marginalized populations. In this review, we highlight major knowledge gaps for each SDOH domain and propose a set of actionable recommendations to inform CVD care, ensure equitable distribution of healthcare resources, and reduce observed disparities.
KW - Cardiovascular disease
KW - Health disparities
KW - Social determinants of health
UR - http://www.scopus.com/inward/record.url?scp=85111337180&partnerID=8YFLogxK
U2 - 10.1007/s11883-021-00949-w
DO - 10.1007/s11883-021-00949-w
M3 - Review article
C2 - 34308497
AN - SCOPUS:85111337180
SN - 1523-3804
VL - 23
JO - Current Atherosclerosis Reports
JF - Current Atherosclerosis Reports
IS - 9
M1 - 55
ER -