What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular health (n=2000). Intervention: Cumulative social risk (CSR) score ≥3 vs. CSR score of 0. Primary outcome: Fewer (<3) ideal cardiovascular health factors (OR 2.67, 95% CI 1.97-3.62, p=<0.001).

What does this research mean for the field?

A cumulative social risk score of 3 or more is associated with significantly higher odds of having fewer ideal cardiovascular health factors compared to a score of zero, a relationship that is partially mediated by psychosocial factors such as depression, stress, and perceived discrimination. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 17, 2022Open Access

Associations between cumulative social risk, psychosocial risk, and ideal cardiovascular health: Insights from the HeartSCORE study

Q: What are the key findings of this study?

A cumulative social risk score of 3 or more was associated with significantly higher odds of having fewer ideal cardiovascular health factors compared to a score of zero (OR 2.67).

Q: What does this research mean for the field?

A cumulative social risk score of 3 or more is associated with significantly higher odds of having fewer ideal cardiovascular health factors compared to a score of zero, a relationship that is partially mediated by psychosocial factors such as depression, stress, and perceived discrimination. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

A cumulative social risk score of 3 or more was associated with significantly higher odds of having fewer ideal cardiovascular health factors compared to a score of zero (OR 2.67).

Study Design

Type

Cross-Sectional (n=2,000)

Multicenter

Structured PICO

Does higher cumulative social risk reduce the probability of achieving ideal cardiovascular health?

Population

2000 participants from the HeartSCORE cohort, mean age 59.1 years, 34.6% male, 42.7% Black, and 29.1% with low income.

Intervention

Higher cumulative social risk (CSR) scores (1, 2, or ≥3) and psychosocial factors (depression, stress, perceived discrimination)

Comparator

Cumulative social risk (CSR) score of zero

Outcome

Fewer ideal cardiovascular health (CVH) factors (<3 factors from AHA's Life's Simple 7)composite

Increased cumulative social risk is strongly associated with a lower probability of achieving ideal cardiovascular health, an effect partially mediated by psychosocial factors like depression and stress.

Main Result

Effect estimate: OR 2.67 (95% CI 1.97-3.62)

p-value: p=<0.001

Limitations

Sample from a single metropolitan area (Pittsburgh) may not be generalizable to a broader national population.
Merged categories 3 and 4 of CSR to avoid low prevalence groups.
Unclear whether the various components of CSR carry equal weight or if effects are additive, sub-additive, or multiplicative.
Definition of race within CSR was self-reported and limited to Blacks as the only minority group.
Did not assess all potential psychosocial risk factors (e.g., anxiety, hostility) or other mediators such as access to healthcare and medication adherence.
Did not account for use of pharmacologic and non-pharmacologic treatment of depression.

Abstract

Limited studies have assessed the effects of psychosocial risk factors on achievement of ideal cardiovascular health (CVH). Using the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) cohort, we examined the cross-sectional associations of cumulative social risk (CSR) and three psychosocial factors (depression, stress, perceived discrimination) with ideal CVH. CSR was calculated by assigning one point for each of: low family income, low education level, minority race (Black), and single-living status. Ideal CVH was calculated by assigning one point for ideal levels of each factor in American Heart Association's Life's Simple 7. Ideal CVH was dichotomized into fewer versus higher by combining participants achieving <3 versus ≥3 factors. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of having fewer ideal CVH factors. Psychosocial factors were assessed as mediators of the association between CSR and ideal CVH. We included 2000 participants (mean age 59.1 7.5 years, 34.6% male, 42.7% Black, and 29.1% with low income), among whom 60.6% had <3 ideal CVH factors. The odds of having fewer ideal CVH factors increased significantly with increasing CSR scores from 1 to 2, to ≥3 compared to individuals with CSR score of zero, after adjusting for age and sex (OR 95% CIs: 1.77 1.41 - 2.22; 2.09 1.62 - 2.69 2.67 1.97 - 3.62, respectively). Taking the components of ideal CVH separately, higher CSR was directly associated with odds of being in ‘non-ideal’ category for six of the seven factors, but was inversely associated with probability of being in ‘non-ideal’ category for cholesterol. The association was modestly attenuated after adjusting for depression, stress, and perceived discrimination (corresponding OR 95% CI: 1.69 1.34 - 2.12, 1.96 1.51 - 2.55, 2.34 1.71 - 3.20). The psychosocial factors appeared to mediate between 10% and 20% of relationship between CSR and ideal CVH. Increased CSR was associated with lower probability of achieving ideal CVH factors. A modest amount of the effect of CSR on ideal CVH appeared to be mediated by depression, stress and perceived discrimination. Public health strategies aimed at improving ideal cardiovascular health may benefit from including interventions targeting social and psychosocial risk factors.

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