The social context and environment as targets for heart failure prevention

The prevalence of heart failure (HF) continues to rise and disproportionately affects disadvantaged populations. This has created an urgent need to concurrently tackle HF prevention and therapeutics, and to look beyond traditional HF risk factors. Several aspects of the social context and environment such as race/ethnicity, social isolation/loneliness, marginalization/segregation, socioeconomic position, air pollution, noise pollution, extreme temperatures, food environment, geographical location and neighborhood socioeconomic status have been recognized as modifiers of HF risk. These factors can be effectively targeted for comprehensive HF prevention. The pathways that link the social context and environment to HF involve psychological, behavioral, and biological mechanisms as well as limited access to care. This review outlines key domains of HF prevention and discusses the evidence linking the social context and environment with HF. We also addressed the mechanistic underpinnings that drive the associations reported and highlight key features of effective HF prevention programs. Finally, we discussed challenges to implementing social and environmental factors as components of HF prevention. To achieve maximal effect, HF prevention should be approached at multiple tiers using a life course approach.