Social factors, lifestyle, environment, and cardiovascular health in Czech middle-aged population

Background The social environment is a key determinant of cardiovascular morbidity and mortality across the life course, particularly in midlife and older age. Its effects are partly mediated through lifestyle behaviours as well as environmental and psychosocial conditions. Methods We analysed data from the Czech arm of the HAPIEE study, applying an exposome framework to capture the combined influence of multiple exposures. Information on social environment in both childhood and adulthood, lifestyle behaviours across different stages of adulthood, psychosocial factors including loneliness, environmental exposures, and self-rated health (SRH) was included. Cardiovascular morbidity and mortality were assessed as outcomes. Associations between exposures and outcomes were examined using structural equation modelling to account for complex pathways. Results The study included over 8,800 men and women aged 45–69 years at baseline, with a follow-up period exceeding 22 years. Higher educational attainment and greater material advantage in adulthood were associated with a reduced risk of cardiovascular outcomes. In contrast, the influence of childhood social environment was weak and not statistically significant. The structural model revealed modest indirect pathways linking education to cardiovascular outcomes through factors such as air pollution exposure and health-related behaviours. Conclusions These findings underscore the importance of policies that enhance educational attainment and promote healthy behaviours in adulthood as strategies to reduce cardiovascular morbidity and mortality. A comprehensive understanding of the interactions between social, behavioural, and environmental factors is crucial for identifying effective interventions in midlife and later life. Key messages • Policies enhancing educational attainment and promoting healthy behaviours in adulthood should be promoted to reduce cardiovascular health. • An understanding of the interactions between social, behavioural, and environmental factors is essential for proposing effective interventions.