Social Determinants of Health in the Twenty-First Century: A Major Contributor to Cardiovascular Death

The following article was written by Dr. Kahtan Fadah as a CardioNerds Conference Scholar for The American Society for Preventive Cardiology (ASPC) 2022 Congress on Cardiovascular Disease Prevention.

The COVID-19 pandemic revealed the wide-gap of race-based health disparities driven by social determinants of health (SDoH) in the progression of CVD, particularly in Black and Hispanic populations. During its annual 2022 Congress, the American Society of Preventive Cardiology (ASPC) sent a clear message emphasizing the importance of defeating these SDoH by 2030 in order to halt (and perhaps reverse) the increasing prevalence of CVD and related health disparities (1).

Despite increased awareness of health inequities, the impact of SDoH on CVD remain understudied. Socioenvironmental stressors such as food insecurity, limited access to medical care, and adversity directly contribute to the pathophysiology of CVD. This is a biological phenomenon. These stressors are a source of chronic inflammation. Dr. Ahmed Ghoneem, CardioNerds Academy Chief of House Taussig, has previously written about how the link between social stressors and CVD pathophysiology can literally be seen on fluorodeoxyglucose (FDG)-positron emission tomography (PET) with the following proposed causal pathway: stressors à amygdala activity à sympathetic nervous system output à hematopoietic tissue activity à target organ inflammation à atherosclerosis (2-5). Therefore, social disadvantages, together with other CVD risk factors such as hypertension, diabetes, smoking, and obesity, aggravate CVD related mortality and morbidity.

Dr. Karol E. Watson, Professor of Medicine/Cardiology, Director of the Women’s Cardiovascular Health Center, the UCLA-Barbra Streisand Women’s Heart Health Program, Co-Director of the Program in Preventive Cardiology, and Director of Cardiovascular Fellowship Program at the David Geffen School of Medicine at UCLA, said “We have to understand that the social determinants account more than so many other things for many of our patients, …The impact of social advantage on health is substantial.”

Social determinants of health are important modifiable risk factors which propagate health disparities in CVD care and outcomes. As we strive for health equality and overall better population health, we need to study the underpinnings and impact of the SDoH and work together to improve the health of every member of our society.

We only see the ICEBRIGE of #racism and this is 😱😨@kewatson #ASPC2022

We need to focus on Social Determinants⚖️ to improve the health of our community @CardioNerds @DrMarthaGulati @DrAlaaDiab @DeveshRaiMD @a_l_bailey pic.twitter.com/qcK5YLObv9

— Kahtan Fadah (@KahtanAlfadhl) July 31, 2022

We all know that stress is bad for our hearts.⚠️❤️

But did you know there is actual evidence of this heart-brain connection on FDG PET/CT?

A #Tweetorial 🧵 #CardioTwitter #MedTwitter #MedEd pic.twitter.com/w6mxow9D2T

— Ahmed Ghoneem, MD MSc (@a_h_ghoneem) June 15, 2022

Reference:

1. Heidenreich, P. A., Albert, N. M., Allen, L. A., Bluemke, D. A., Butler, J., Fonarow, G. C., Ikonomidis, J. S., Khavjou, O., Konstam, M. A., Maddox, T. M., Nichol, G., Pham, M., Piña, I. L., Trogdon, J. G., American Heart Association Advocacy Coordinating Committee, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Radiology and Intervention, Council on Clinical Cardiology, Council on Epidemiology and Prevention, & Stroke Council (2013). Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Heart failure, 6(3), 606–619. https://doi.org/10.1161/HHF.0b013e318291329a
2. Ghoneem, A. [@a_h_ghoneem]. (2022, June 15). We all know that stress is bad for our hearts. But did you know there is actual evidence of this heart-brain connection on FDG PET/CT? [Tweet]. Twitter. https://twitter.com/a_h_ghoneem/status/1537132448525561862?s=21&t=sloVGVNnPp8wQe4gqHGItQ
3. Tawakol, A., Ishai, A., Takx, R. A., Figueroa, A. L., Ali, A., Kaiser, Y., Truong, Q. A., Solomon, C. J., Calcagno, C., Mani, V., Tang, C. Y., Mulder, W. J., Murrough, J. W., Hoffmann, U., Nahrendorf, M., Shin, L. M., Fayad, Z. A., & Pitman, R. K. (2017). Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study. Lancet (London, England), 389(10071), 834–845. https://doi.org/10.1016/S0140-6736(16)31714-7
4. Fiechter, M., Roggo, A., Burger, I. A., Bengs, S., Treyer, V., Becker, A., Marȩdziak, M., Haider, A., Portmann, A., Messerli, M., Patriki, D., Mühlematter, U. J., von Felten, E., Benz, D. C., Fuchs, T. A., Gräni, C., Pazhenkottil, A. P., Buechel, R. R., Kaufmann, P. A., & Gebhard, C. (2019). Association between resting amygdalar activity and abnormal cardiac function in women and men: a retrospective cohort study. European heart journal. Cardiovascular Imaging, 20(6), 625–632. https://doi.org/10.1093/ehjci/jez047
5. Osborne, M. T., Radfar, A., Hassan, M., Abohashem, S., Oberfeld, B., Patrich, T., Tung, B., Wang, Y., Ishai, A., Scott, J. A., Shin, L. M., Fayad, Z. A., Koenen, K. C., Rajagopalan, S., Pitman, R. K., & Tawakol, A. (2020). A neurobiological mechanism linking transportation noise to cardiovascular disease in humans. European heart journal, 41(6), 772–782. https://doi.org/10.1093/eurheartj/ehz820