Impact of social determinants of cardiovascular disease risk

When assessing cardiovascular disease (CVD) risk in women, nonbiological factors and social determinants of health should be included, according to a recent statement from the American Heart Association (AHA).

“Risk assessment is the first step in preventing heart disease, yet there are many limitations to traditional risk factors and their ability to comprehensively estimate a woman’s risk for cardiovascular disease,” said Jennifer H. Mieres, MD, FAHA, vice chair of the scientific statement writing committee and professor of cardiology at the Zucker School of Medicine in Hempstead, NY.

The issue of social determinants is especially necessary to assess in women of diverse races and ethnicities, as racial and ethnic diversity is currently lacking in patient data registries where data for CVD assessment is gathered. In 2022, an AHA presidential advisory stated understanding how race and ethnicity impact CVD risk is critical to reducing the burden of CVD in women of diverse backgrounds.

Blood pressure, cholesterol, type 2 diabetes, smoking status, family history, diet, physical activity, and weight are all factors traditionally used to measure CVD risk. Sex-specific biological influences and medications more often seen in women than men are not considered in these formulas.

According to the AHA, CVD risk assessments should include pregnancy-related conditions, menstrual cycle history, type of birth control or hormone replacement therapy used, history of chemotherapy or radiation therapy, polycystic ovarian syndrome, autoimmune disorders, and depression and posttraumatic stress disorder.

Social detriments impacting CVD risk include economic stability, working conditions, neighborhood safety, education level, environmental hazards, and quality health care access. These factors must be included in risk assessment to improve health outcomes, according to Laxmi S. Mehta, MD, FAHA, director of preventative cardiology and women’s cardiovascular health at The Ohio State University Wexner Medical Center in Columbus, Ohio.

Significant racial and ethnic differences in CVD risk profiles are also discussed in the statement. Non-Hispanic Black women are the most likely to have obesity, develop type 2 diabetes, and die of smoking related diseases. This population often experiences CVD at a younger age.

Higher rates of obesity are also seen in Hispanic women compared to Hispanic men, and those in the United States have higher rates of smoking. However, while this group has higher rates of type 2 diabetes, obesity, and metabolic syndrome, CVD deaths are 15% to 20% lower. Researchers hypothesized this is because of diverse Hispanic subcultures being grouped together for analysis.

Tobacco use is higher in American Indian and Alaska Native women, and type 2 diabetes is a risk factor for CVD prevalence in American Indian women. Small sample sizes leave cardiovascular health data in these groups incomplete.

CVD risk varies in Asian American women based on subgroups. Chinese women have high blood pressure rates of 30% and Filipino women 53%. Southeast Asian women experience the greatest prevalence of type 2 diabetes.

“When customizing CVD prevention and treatment strategies to improve cardiovascular health for women, a one-size-fits-all approach is unlikely to be successful,” Mieres said. “We must be cognizant of the complex interplay of sex, race and ethnicity, as well as social determinants of health, and how they impact the risk of cardiovascular disease and adverse outcomes in order to avert future CVD morbidity and mortality.”

Guidelines tailored to cultural norms could further prevent CVD in diverse populations. Research should also be conducted to address gaps in knowledge on risk factors specific to race and ethnic subgroups.

Reference

Non-biological factors and social determinants of health important in women’s CVD risk assessment. EurekAlert. April 10, 2023. Accessed April 11, 2023. https://www.eurekalert.org/news-releases/985273