Achieving Optimal Cardiovascular Health: a Social Epidemiological Approach
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Purpose of Review
The American Heart Association (AHA) created the cardiovascular health (CVH) index to measure and monitor population-level reduction of cardiovascular disease (CVD) risk, with a goal of 20% reduction in CVD morbidity and mortality by 2020. Few U.S. adults meet all seven ideal CVH metrics (non-smoking behavior, healthy diet and body weight, active lifestyle, good cholesterol, glucose, and blood pressure scores), with 17% of men and women only achieving five or more ideal CVH metrics. This review describes the importance of considering sociodemographic, psychosocial, and behavioral factors as key strategies to achieve the AHA 2020 goals.
Men, racial/ethnic minorities, and individuals of lower socioeconomic status are less likely to achieve ideal CVH—which may start in early childhood. An emerging body of literature indicates that individuals with high-quality social relationships, positive childhood experiences and psychological functioning, along with lifestyle factors, may impact attainment of optimal CVH. For example, exploring the role of food insecurity in CVH attainment demonstrates the complex interplay between contextual factors and lifestyle behaviors that may promote or deter ideal CVH. Evidence also suggests that the CVH index has convergent validity with intermediate and hard endpoints of CVD. Interventions that seek to promote multi-system resiliency may help close the gap in attainment of the AHA 2020 goals.
Research on psychosocial and behavioral factors suggests that social connections, psychological resources, and health-maintaining behaviors are important areas to target to improve CVH in minorities and other vulnerable groups.
KeywordsIdeal cardiovascular health Cardiovascular disease risk Psychosocial factors Socioeconomic status Social epidemiology Social determinants of health
Dr. Durazo was supported by a National Institute on Aging grant T32AG049663. Dr. Rodriguez was funded in part by the Center of Excellence Faculty Fellowship, Stanford University, the US Department of Health and Human Services, the Hispanic Center of Excellence.
Compliance with Ethical Standards
Conflict of Interest
Tomás Cabeza de Baca, Eva M. Durazo, and Fatima Rodriguez declare no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
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