Individuals exposed to adverse neighborhood social factors in early adulthood demonstrated a higher risk of developing coronary artery calcification in midlife, a key measure of early cardiovascular disease, according to a recent study published in Nature Communications.
The association between cardiovascular disease risk and adverse social determinants of health was found using a novel index developed by Northwestern Medicine scientists that integrates neighborhood socioeconomic characteristics, food availability, physical activity facilities and crime rates.
“This study helps move the field forward by shifting from a focus on individual lifestyle risk factors to a more comprehensive understanding of how neighborhood context shapes health,” said Lifang Hou, MD, PhD, professor of Preventive Medicine and of Pediatrics, who was senior author of the study.
Cardiovascular disease is the leading cause of death in the U.S. and worldwide, according to the Centers for Disease Control and Prevention.
The neighborhood and surrounding environment in which a person lives have been shown to influence their cardiovascular health and overall risk for cardiovascular disease.
While previous work has shown how individual social factors, such as income or education, impact cardiovascular health, few studies have investigated how multiple neighborhood factors influence a person’s cardiovascular risk over time, according to Hou.
“We identified a critical knowledge gap: the need for a more comprehensive way to measure neighborhood social determinants of health and understand how these exposures, starting in early adulthood, influence cardiovascular risk across the life course,” said Hou, who is also director of the Center for Global Oncology at the Robert J. Havey, MD Institute for Global Health.
To address this gap, Hou’s team used data from the CARDIA (Coronary Artery Risk Development in Young Adults) study — a longitudinal cohort study examining how behavioral, environmental and race- and sex-associated factors impact cardiovascular disease development and aging — to develop a novel neighborhood social determinants of health index. The scientists then linked this index to coronary artery calcification (CAC), a key indicator of early cardiovascular disease, that had been measured over time.
Next, using advanced statistical and machine learning approaches, the scientists evaluated how neighborhood social determinants were associated with cardiovascular risk while accounting for individual-level factors. They also studied how these associations varied across different patient populations.
They found that people who were exposed to more adverse neighborhood social determinants of health in early adulthood had a higher risk of developing CAC later in life, and that these associations were stronger among Black participants, as compared to white participants.
The findings show that early-life neighborhood social determinants have lasting biological effects on cardiovascular health, which could help inform more context-aware risk assessment in clinical care, population- and community-level prevention strategies, and approaches to better understand and address variation in cardiovascular risk, Hou said.
“By integrating multiple neighborhood social determinants into a single index, we can better capture how these factors accumulate over time and influence cardiovascular risk. Importantly, our findings show that neighborhood social determinants are not just abstract concepts — they are linked to measurable biological changes, such as coronary artery calcification,” Hou said.
Hou said her team aims to extend this work to other cardiovascular outcomes, such as myocardial infarction and heart failure, and to identify modifiable neighborhood social determinants of health that could serve as targets for invention.
Additionally, the scientists aim to validate their index in other patient cohorts and geographic settings and better understand how changes in neighborhood conditions over time impact cardiovascular disease risk.
“This study highlights the unique value of long-term longitudinal research in uncovering how early-life neighborhood environments shape health across decades, providing important evidence to inform both clinical practice and population health strategies,” Hou said.
Tao Gao, MD, research assistant professor of Preventive Medicine, was lead author of the study.
Brian Joyce, PhD, assistant professor of Preventive Medicine, was a co-author of the study.
The CARDIA study is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (75N92023D00002 and 75N92023D00005), Northwestern University (75N92023D00004), University of Minnesota (75N92023D00006) and Kaiser Foundation Research Institute (75N92023D00003). CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging (NIA) and an intra-agency agreement between NIA and NHLBI (AG0005). This work was also supported by American Heart Association grants 17SFRN33700278 and 14SFRN20790000 and NIA grants R01AG069120, R01AG081244 and U01AG088658.
