Aaron L. Troy, Anjali Bhatla, Scott A. Berkowitz, Roger S. Blumenthal, Thomas Cudjoe, Parag Goyal, D. Elizabeth Le, Chiadi E. Ndumele, Rishi K. Wadhera, Gary Gerstenblith, Abdulla A. Damluji
Social determinants of health are major drivers of adverse cardiovascular outcomes throughout the life course. As the population ages, understanding how social determinants influence vascular, myocardial, valvular, and electrophysiologic aging trajectories will be essential to improving cardiovascular outcomes. This review summarizes key frameworks for social determinants of health and cardiovascular aging, then examines social determinants' impacts on cardiovascular aging focusing on behavioral, biological, and health care-related mediators. Specifically, the review highlights race/ethnicity, gender, geographic context, and education as structural determinants with impact starting early in life; followed by food security, digital access, and financial security as intermediary determinants requiring targeted intervention in adulthood; then social connection, transportation access, and homebound status as intermediary determinants with outsized impact in elderhood. The review spotlights patient-, population-, and policy-level interventions for each determinant, as well as key considerations for improving atherosclerosis, heart failure, valvular, and atrial fibrillation outcomes, and priorities for study and intervention.