Social Determinants of Cardiovascular Health

In the last issue of the Journal of Cardiovascular Nursing (May/Jun 2025, 40:3), we included a special section titled Social Determinants of Cardiovascular Health that featured articles that cover various topics related to social determinants of cardiovascular health and health equity. Social determinants of health are defined as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”1Healthy People 2030 categorizes social determinants of health into 5 domains: (1) economic stability, (2) education access and quality, (3) healthcare access and quality, (4) neighborhood and built environment, and (5) social and community context. Four articles in the special issue examined social determinants within the domain of social and community context, including social support, social isolation, loneliness, and dyadic coping. De Sales and colleagues2 conducted a descriptive cross-sectional study that examined the influence of social support on hypertension management in 213 adults with hypertension in Brazil. Participants who reported high levels of social support demonstrated higher odds of having controlled blood pressure compared with those with low/moderate social support.2 This study was one of the first to examine psychosocial factors associated with hypertension management in Brazil. In another cross-sectional study of 416 patients with hypertension in China, investigators conducted mediation analyses, which revealed that approximately 41% of the effect of high blood pressure–related health literacy on health-related quality of life was explained by social support and hypertension self-management.3 An additional study sought to explore the relationships between social isolation, loneliness, and heart failure self-care. Investigators conducted a secondary analysis of data from 49 patients with heart failure who participated in a home-based exercise intervention.4 They found that lower social isolation was significantly associated with higher self-care maintenance, monitoring, and management among adults with heart failure.4 However, loneliness did not impact heart failure self-care.4 Findings from these studies suggest that enhancing social support and reducing social isolation may be important targets for interventions to improve hypertension and heart failure management. Another cross-sectional study of 741 adults with hypertension in China investigated the relationship between dyadic coping and frailty.5 The authors first identified 5 latent profiles of dyadic coping ranging from severely impaired to highest dyadic coping.5 The probability of meeting the criteria for frailty was 2 to 2.6 times higher among those with severely impaired and mildly impaired dyadic coping.5 Two articles in the special issue demonstrate how the neighborhood and built environment can affect cardiovascular health. In an integrative review of 27 studies, Hajj and colleagues6 investigated the associations of neighborhood characteristics and socioeconomic status with subclinical atherosclerosis. The authors identified 3 key themes: (1) environmental exposure affects progression of subclinical atherosclerosis, (2) neighborhood characteristics are associated with subclinical atherosclerosis, and (3) individual socioeconomic status is associated with the development and progression of subclinical atherosclerosis more than neighborhood socioeconomic status.6 Another article by Meraz et al7 reported findings from a secondary analysis of cross-sectional data from a mixed-method study that examined the influence of neighborhood disadvantage (measured using the Area Deprivation Index) on heart failure self-care in a diverse sample of 83 adults with heart failure. Investigators found that both living in a neighborhood with greater socioeconomic disadvantage and living alone were associated with worse heart failure self-care maintenance and monitoring.7 Although household income, race, gender, age, and marital status were not associated with heart failure self-care, participants with no college education had significantly lower self-care maintenance.7 The remaining 2 articles assessed differences in cardiovascular health across race, ethnicity, and/or sex/gender. In a systematic review of 15 studies, Howard et al8 identified several racial and sex/gender differences in cardiovascular health (assessed using the American Heart Association's Life's Simple 7 or Life's Essential 8). People of color (aged 18–50 years) had lower cardiovascular health scores than non-Hispanic White individuals.8 Cardiovascular health scores were lowest among non-Hispanic Black adults.8 Their findings show continued cardiovascular health disparities among people of color in the United States that must be addressed in future work. Moreover, in an analysis of cross-sectional data from the National Health and Nutrition Examination Survey, Tanglai and colleagues9 investigated sex-based differences in hypertension risk factors among 815 non-Hispanic Asian adults. They found that increasing age, higher body mass index, and higher uric acid were significant risk factors for hypertension among Non-Hispanic Asian men and women.9 Marital status and elevated blood glucose were only associated with hypertension among men.9 The articles in this special issue highlight important work that is relevant to cardiovascular nurses and other clinicians. Findings contribute to growing evidence of the important role that social determinants play in shaping cardiovascular health. The evidence presented in this special issue was derived from observational studies, which underscores the need to develop clinical and public health interventions that address social determinants to improve the prevention and management of cardiovascular diseases. Nurse scientists must expand research efforts to not only understand but also address the impact of adverse social determinants on cardiovascular outcomes. We hope that the compelling findings presented in this special issue will stimulate additional work to further understand and address social determinants of cardiovascular health across diverse patient populations.