MGH Study Links Socioeconomic Status and Cardiovascular Disease

A recent study by Massachusetts General Hospital (MGH) discovered a link between socioeconomic status and cardiovascular risk, making clear the need to better understand the social determinants of health.

Published in the Journal of the American College of Cardiology, the study found that individuals who lived in zip codes with lower socioeconomic status or higher crime rates were at an increased risk for a major adverse cardiac event such as a heart attack, unstable angina, heart failure, or cardiac death.

Building off an earlier study in 2017 showing a relationship between the amygdala — the brain’s stress-response structure — and an elevated risk of cardiovascular events, this new study showed an increase in resting amygdala activity among those living in low-income neighborhoods. A similar association was seen between amygdala activity and those residing in high crime neighborhoods, but these results were not statistically significant.  

The study had 289 participants. Using the participant’s address, the study investigators were able to ascertain their socioeconomic status using census data from the participants’ zip code. PET/CT brain imaging with a radiopharmaceutical measured brain activity and arterial inflammation. Funding for the study came from grants from the National Institute of Health and the American Heart Association.

“This new study identifies a potentially modifiable biological pathway that contributes to the increased burden of cardiovascular disease that encumbers socioeconomically disadvantaged individuals,” explained lead author Ahmed Tawakol, MD, director of nuclear cardiology in the MGH Division of Cardiology. “These observations point to a mechanism that may be an attractive target for future therapies aimed at reducing disparities in health outcomes.” 

It is well known that risk factors such as smoking status, obesity, and inadequate access to care are associated with cardiovascular disease. Even after adjusting for these known risk factors, the study still showed that individuals in areas of lower socioeconomic status or higher crime rates were at an increased risk for major adverse cardiac events. 

“These results provide further support for considering socioeconomic status when assessing an individual’s risk for cardiovascular disease and suggest new approaches to helping reduce cardiovascular risk among those patients,” said Tawakol.

This evidence demonstrates a need to focus on social determinants of health, the conditions outside of traditional notions of health that affect an individual’s wellbeing such as socioeconomic status, food insecurity, inadequate transportation, and educational attainment. Social determinants of health have shown to be strongly linked to chronic disease onset.  Yet providers are still struggling with how to manage these problems with their patients.

“These analyses highlight the incredible opportunity we have to apply recent advances in the understanding of human biology to addressing disparities in health,” stated Katrina Armstrong, MD, chief of the MGH Department of Medicine and senior author of the study.

Because social determinants of health are so strongly linked to where an individual lives and works, creating healthier communities and eliminating disparities must begin within the community.

Payers in the public and the private sector are investing millions into community engagement to help address the social determinants of health in their member populations. These programs assess the needs of a community from community members and engage them better lifestyle practices. Programs like insurer-funded housing for homeless, healthy food delivery to patients, and ride sharing capabilities to doctors appointments are among several strategies currently being used to address the social determinants of health needs in communities.

Tawakol and his colleagues hope this most recent work will be used to further evaluate potential interventions for reducing the risk of cardiovascular events among these populations.