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Current Atherosclerosis Reports
Published in: Current Atherosclerosis Reports 9/2021

01-09-2021 | Reviews and New Research Implications (S. Virani, Section Editor)

Social Determinants of Health and Cardiovascular Disease: Current State and Future Directions Towards Healthcare Equity

Authors: Mohammad Hashim Jilani, Zulqarnain Javed, Tamer Yahya, Javier Valero-Elizondo, Safi U. Khan, Bita Kash, Ron Blankstein, Salim S. Virani, Michael J. Blaha, Prachi Dubey, Adnan A. Hyder, Farhaan S. Vahidy, Miguel Cainzos-Achirica, Khurram Nasir

Published in: Current Atherosclerosis Reports | Issue 9/2021

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Abstract

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.
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Metadata
Title
Social Determinants of Health and Cardiovascular Disease: Current State and Future Directions Towards Healthcare Equity
Authors
Mohammad Hashim Jilani
Zulqarnain Javed
Tamer Yahya
Javier Valero-Elizondo
Safi U. Khan
Bita Kash
Ron Blankstein
Salim S. Virani
Michael J. Blaha
Prachi Dubey
Adnan A. Hyder
Farhaan S. Vahidy
Miguel Cainzos-Achirica
Khurram Nasir
Publication date
01-09-2021
Publisher
Springer US
Published in
Current Atherosclerosis Reports / Issue 9/2021
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-021-00949-w

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