Social Determinants of Health and Prevention of Cardiovascular Disease
Research demonstrates that socioeconomic inequalities are "strong determinants" of cardiovascular risk throughout the world.
Members of the writing committee for the American College of Cardiology/American Heart Association 2019 Guideline on Primary Prevention of Cardiovascular Disease incorporated throughout the guideline consideration of how social determinants of health may impact the efficacy of specific guidance and prescriptions for an individual patient. ACC/AHA recommends that clinicians revisit these considerations at each follow-up visit.
Considerations include but are not limited to socioeconomic and educational status as well as cultural, home, and employment environments. The slides below highlight examples of considerations cited by the ACC/AHA for 7 health domains.
Cardiovascular Risk: Routinely assess for psychosocial stressors related to SDOH and provide counseling as necessary.
Diet: Assess perception of body size as well as social and cultural influences that may be relevant to improving food choices.
Barriers to heatlhy eating: Economic factors and food access may present barriers to following a heart-healthy diet and should be assessed, particularly in residents in inner cities, of low socioeconomic means, and of older age.
Exercise/physical activity: Assess neighborhoods for access to facilities for physical activity.
Obesity/weight loss: Lifestyle counseling should address psychosocial stressors, sleep hygeine, and other personal barriers to weight loss.
Diabetes mellitus: To support reaching glycemic control, assess factors including depression, stress, self-efficacy, and social supports.
Elevated blood pressure: Consider influences on elevated blood pressure such as poor quality sleep and short sleep duration when considering intervention, as well as diet quality and access to recreational space.
Source: Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596–e646. doi10.1161/CIR.0000000000000678
