A new analytical study exploring how social determinants of health influence cardiac ageing has identified financial strain and food insecurity as the most potent contributors to accelerated biological ageing of the heart and a heightened risk of death. The research demonstrates that these social pressures exert a more substantial effect than many traditional clinical risk factors, highlighting the intricate ways in which social and economic conditions shape cardiovascular outcomes. Published in Mayo Clinic Proceedings, the findings highlight the need for prevention strategies that go beyond purely biomedical models of care.
The study emerges at a time of profound demographic change. In the United States, the population aged 65 and over is projected to almost double by 2050, reaching approximately 82 million people, or nearly a quarter of the total population. As life expectancy rises, healthcare priorities have increasingly shifted towards promoting healthy ageing and preserving quality of life in later years. This transition has fuelled interest in identifying more meaningful measures of biological ageing, rather than relying solely on chronological age, to predict disease risk and guide interventions better.
According to lead investigator Dr Amir Lerman of the Mayo Clinic’s Department of Cardiovascular Medicine, the research was driven by growing evidence that conventional cardiovascular risk factors do not account equally for disease burden across patients. He notes that social influences on health are often overlooked in clinical settings, mainly because they are not routinely assessed or discussed. These unrecognised factors, he suggests, may play a significant role in accelerating biological ageing and could represent opportunities for intervention if correctly identified.
The cross-sectional analysis included data from more than 280,000 adults who received care at the Mayo Clinic between 2018 and 2023. Researchers evaluated social determinants of health using a comprehensive questionnaire covering nine domains: stress, physical activity, social connections, housing instability, financial strain, food insecurity, transport needs, nutrition, and education. Cardiac age was estimated using an artificial intelligence–enabled electrocardiogram. At the same time, advanced statistical modelling was employed to examine how social factors, traditional risk factors, and comorbidities interact to influence the gap between cardiac and chronological age.
A central concept in the study is the “cardiac age gap, which reflects the difference between a person’s biological heart age and their actual age. A larger gap indicates an older biological heart and a greater likelihood of future cardiovascular disease. The findings demonstrate that the combined influence of social determinants was the most significant driver of this gap, surpassing traditional clinical factors. Among all social variables assessed, financial strain and food insecurity consistently showed the strongest association with accelerated cardiac ageing, both in the overall population and when analysed by sex. Several social factors, including housing instability and physical inactivity, were also found to predict mortality risk at levels comparable to, or exceeding, established medical risks.
The authors acknowledge limitations, noting that the AI-based ECG tool was validated within a single healthcare system and that most participants identified as non-Hispanic White, which may limit generalisability to other populations. Nevertheless, the study underscores the importance of integrating social context into cardiovascular care. Dr Lerman concludes that recognising and addressing key social determinants can enable more targeted prevention efforts and support genuinely patient-centred care, ultimately improving heart health by confronting the broader conditions that contribute to disease.
More information: Nazanin Rajai et al, Interplay of Social Determinants of Health and Traditional Risk Factors in Predicting Cardiac Aging, Mayo Clinic Proceedings. DOI: 10.1016/j.mayocp.2025.01.024
Journal information: Mayo Clinic Proceedings Provided by Elsevier
