Psychological and socio-economic correlates of cardiovascular health among young adults in Puerto Rico

• Rates of cardiovascular disease (CVD) and stroke have not decreased or have even increased among young adults compared with older adults. • Cardiovascular health (CVH) in young adulthood predicts CVD outcomes in later years. • Socioeconomically disadvantaged and minoritized groups experience worse CVH, especially at younger ages. • In issuing its updated metric (Life's Essential 8, or LE8) to monitor the CVH of individuals and populations, the American Heart Association recommends further research to identify specific social determinants and psychological factors that are foundational to CVH. • In a community sample of young adults in Puerto Rico, lower subjective social standing and elevated symptoms of anxiety and depression were the socioeconomic and psychological variables with the strongest associations with suboptimal (vs. ideal) CVH, as assessed by the LE8 metric. We aimed to determine the relationship between socioeconomic and psychological factors and overall cardiovascular health (CVH), as defined by the American Heart Association's Life's Essential 8 (LE8), among young adults in Puerto Rico. Participants were 2156 young adults, between the ages of 18–29 years, enrolled in the PR-OUTLOOK study. The analysis included survey, laboratory, and physical measurement data collected from September 2020 to November 2023. Assessed socioeconomic indicators included food insecurity, housing instability, economic insecurity, and subjective social standing. Evaluated psychological factors comprised symptoms of depression, anxiety, post-traumatic stress, and overall perceived stress. LE8 scores were calculated and classified as suboptimal (poor/intermediate range) vs. ideal CVH. Logistic regression models estimated associations between each socioeconomic and psychological measure and suboptimal CVH, and dominance analysis assessed the importance of each measure. Participants' mean age was 22.6 (SD = 3.1), 60.9 % were female, about one-third (34.2 %) had high school education or less, and over one-third had public or no health insurance (38.4 %). Participants reporting socioeconomic adversity (i.e., high food insecurity, housing instability and economic insecurity, and low subjective social standing) and elevated psychological symptoms (i.e., symptoms of anxiety, depression, post-traumatic stress, and overall perceived stress) had lower CVH scores. However, in the adjusted analysis, only lower subjective social standing (OR = 1.38, 95 % CI = 1.13–1.69) and elevated symptoms of anxiety (OR = 1.63, 95 % CI = 1.25–2.13) and depression (OR = 1.30, 95 % CI = 1.03–1.65) emerged as the primary contributors to suboptimal CVH (vs. ideal). Efforts to preserve and enhance CVH among young Puerto Ricans on the island should target these factors.