Where a person lives during early adulthood may influence their heart health decades later. A recent study found that people exposed to more unfavorable neighborhood social conditions when they were young adults had a greater likelihood of developing coronary artery calcification by midlife. Coronary artery calcification is an important marker of early cardiovascular disease. The findings were published in Nature Communications.
Northwestern Medicine researchers identified the connection using a new index designed to capture several neighborhood social determinants of health at once. The measure incorporates socioeconomic conditions, access to food, opportunities for physical activity and local 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.
How Neighborhoods Can Influence Heart Health
Cardiovascular disease remains the leading cause of death both in the U.S. and worldwide, according to the Centers for Disease Control and Prevention.
Previous research has shown that the neighborhood and surrounding environment where someone lives can influence cardiovascular health and overall heart disease risk.
Researchers have also established links between individual social factors, including income and education, and cardiovascular health. Far fewer studies, however, have examined how several neighborhood conditions acting together may shape cardiovascular risk over many years, 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.
Tracking Cardiovascular Risk Over Time
To investigate that question, Hou and her colleagues analyzed information 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 -- and used the data to create a new neighborhood social determinants of health index.
The researchers then compared scores on that index with coronary artery calcification (CAC), an established indicator of early cardiovascular disease that had been measured repeatedly over time.
Using advanced statistical techniques and machine learning, the team examined the relationship between neighborhood social conditions and cardiovascular risk while also taking individual-level factors into account. They further investigated whether the associations differed among patient populations.
The results showed that participants who experienced more adverse neighborhood social conditions in early adulthood faced a higher risk of developing CAC later in life. The association was also stronger among Black participants compared with white participants.
Neighborhood Conditions May Leave Biological Effects
According to Hou, the results suggest that neighborhood social conditions earlier in life may have lasting biological consequences for cardiovascular health. The findings could eventually contribute to clinical risk assessments that better account for a patient's broader circumstances, as well as population- and community-level prevention strategies and efforts to understand differences in cardiovascular risk.
"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.
The researchers now plan to investigate whether the same neighborhood factors are associated with additional cardiovascular outcomes, including myocardial infarction and heart failure. Hou said the team also wants to identify modifiable neighborhood social determinants of health that could potentially become targets for intervention.
The scientists also plan to test the index in other patient populations and geographic areas. Another goal is to determine how changes in neighborhood conditions over time may alter 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.
Study Authors and Funding
Tao Gao, MD, research assistant professor of Preventive Medicine, was the study's lead author.
Brian Joyce, PhD, assistant professor of Preventive Medicine, was a co-author.
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.
