Cardiovascular health (CVH) is affected by genetic, social, and genomic factors across the life course, yet little research has focused on the interrelationships among them. An extensive body of work has documented the impact of social determinants of health at both the structural and individual levels on CVH, highlighting pathways in which racism, housing, violence, and neighborhood environments adversely affect CVH and contribute to disparities in cardiovascular disease. Genetic factors have also been identified as contributors to risk for cardiovascular disease. Emerging evidence suggests that social factors can interact with genetic susceptibility to affect disease risk. Increasingly, social factors have been shown to affect epigenetic markers such as DNA methylation, which can regulate gene and protein expression. This is a potential biological mechanism through which exposure to poor social determinants of health becomes physically embodied at the molecular level, potentially contributing to the development of suboptimal CVH and chronic disease, thus reinforcing and propagating health disparities. The objective of this statement is to highlight and summarize key literature that has examined the joint associations between social, genetic, and genomic factors and CVH and cardiovascular disease.

Read the full publication: Suglia SF, Hidalgo B, Baccarelli AA, et al. Improving Cardiovascular Health Through the Consideration of Social Factors in Genetics and Genomics Research: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes. 2025;18(5):e000138. doi:10.1161/HCQ.0000000000000138
https://www.ahajournals.org/doi/10.1161/HCQ.0000000000000138?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Sleep quality is a known marker of overall health and is a chronic health issue in the US.^1,2 In addition to the racial and ethnic disparities affecting sleep quality, studies suggest that adverse childhood experiences (ACEs) are associated with sleep disturbances and other chronic diseases among adults.^3,4 ACEs are defined as stressful or traumatic life events that occur during the first 18 years of life.⁵ It is estimated that approximately 58% of youths in the US have experienced at least 1 or more ACE, with a higher prevalence of ACEs among Black and non-White Hispanic children.^5–7 Our research group previously found a significant association between childhood adversity and poor sleep outcomes among Puerto Rican children.⁸ Although ACEs can be assessed both prospectively during childhood and retrospectively in adulthood, no previous study on ACEs and sleep quality has used both forms of reporting, to our knowledge. Despite the utility of retrospective ACEs and patient preference to be screened, both patients and physicians reported that fewer than 10% of adult patients were asked about ACEs.^9,10 Furthermore, research has shown low agreement between prospective and retrospective ACEs, suggesting that these 2 forms of reporting may identify distinct groups of people with unique risk factors for various health outcomes.^11,12

Compared with previous research on ACEs and sleep, our study introduces a new age group to consider: young adults. Young adults, defined as approximately 18 to 26 years of age, are an underrepresented population in research.¹³ Young adulthood is a critical period of complex cognitive and emotional maturation, including increased rates of risky behavior and accidental death.¹³ Despite the high incidence of mental and physical health issues among young adults, this population is less likely to seek health care or undergo routine screening compared with other age groups.¹⁴

Considering the disparities in research that exist for Puerto Rican young adults, as well as the promising importance of exploring both retrospective and prospective ACEs, our study examines the association of prospective and retrospective ACEs with sleep quality in a geographically diverse population of Puerto Rican young adults. Understanding this association has the potential to inform interventions to address ACEs, improve sleep quality, and reduce health disparities for Puerto Rican young adults.

Read the full paper: Olsen EL, April-Sanders AK, Bird HR, Canino GJ, Duarte CS, Suglia SF. Adverse Childhood Experiences and Sleep Disturbances Among Puerto Rican Young Adults. JAMA Netw Open. 2024;7(4):e247532.
https://journals.lww.com/psychosomaticmedicine/abstract/2024/04000/cumulative_stress_across_the_life_course_and.3.aspx

Psychosocial stressors have been linked with accelerated biological aging in adults; however, few studies have examined stressors across the life course in relation to biological aging. In 359 individuals (57% White, 34% Black) from the Child Health and Development Studies Disparities study, economic (income, education, financial strain), social (parent-child relations, caretaker responsibilities) and traumatic (death of a sibling or child, violence exposure) stressors were assessed at multiple time points (birth and ages 9, 15, and 50 years). Experiences of major discrimination were assessed at age 50. Life period stress scores were then assessed as childhood (birth–age 15 years) and adulthood (age 50 years). At age 50 years, participants provided blood samples, and DNA methylation was assessed with the EPIC BeadChip. Epigenetic age was estimated using six epigenetic clocks (Horvath, Hannum, Skin and Blood age, PhenoAge, GrimAge, Dunedin Pace of Aging). Age acceleration was determined using residuals from regressing chronologic age on each of the epigenetic age metrics. Telomere length was assessed using the quantitative polymerase chain reaction–based methods. In linear regression models adjusted for race and gender, total life stress, and childhood and adult stress independently predicted accelerated aging based on GrimAge and faster pace of aging based on the DunedinPace. Associations were attenuated after adjusting for smoking status. In sex-stratified analyses, greater childhood stress was associated with accelerated epigenetic aging among women but not men. No associations were noted with telomere length. We found that cumulative stressors across the life course were associated with accelerated epigenetic age, with differences by sex (e.g., accelerated among women). Further research of this association in large and diverse samples is needed.

Read the full paper: Suglia, Shakira F. MS, ScD; Clausing, Elizabeth S. PhD; Shelton, Rachel C. ScD; Conneely, Karen PhD; Prada-Ortega, Diddier MD, PhD; DeVivo, Immaculata PhD; Factor-Litvak, Pam PhD; Cirillo, Piera PhD; Baccarelli, Andrea A. PhD; Cohn, Barbara PhD; Link, Bruce G. PhD. Cumulative Stress Across the Life Course and Biological Aging in Adulthood. Psychosomatic Medicine 86(3):p 137-145, April 2024.
https://link.springer.com/article/10.1007/s40615-021-00978-w

As part of the Boricua Youth Study – Health Assessment study, which examines the cardiovascular health of Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY, we recently published on the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among this population.

The BYS-HA study conducted home visits to collect objective anthropometric, blood pressure and blood samples when participants were on average 23 years of age. Information on diet, physical activity and sleep were collected via surveys. In addition to calculating measures of obesity, diabetes and hypertension we also calculated a measure of ideal cardiovascular Health (CVH). We utilized the American Heart Association, Life’s Essential 8 metric which includes 8 markers of cardiovascular health: adequate sleep, healthy diet, physical activity, no tobacco exposure, blood pressure, weight status, diabetes and lipids. We characterized CVH scores as continuous with higher scores indicating more optimal CVH and categorically (80-100 scores for ideal CVH). We examined different prevalence of cardiometabolic risk factors and CVH by site (NY vs PR) and by sex.

In this sample of 759 participants, 413 of the participants lived in Puerto Rico with 346 in the South Bronx NY. The mean age of participants was 22.6 years and 50% were female. Twenty-seven percent of the sample received public assistance in young adulthood. Overall, there was a high prevalence of obesity and high HBA1C (≥5.7, a measure of diabetes risk) with noted differences across study site. Participants in NY had a higher prevalence of obesity (35% in NY and 19% in PR) and hypertension (8% in NY and 2% in PR). Across both sites, men had a higher prevalence of hypertension, but women had a higher prevalence of obesity and low total cholesterol compared to men. In both NY and PR, women had better blood pressure and lipids but lower physical activity compared to men. In PR, women also had better diet and nicotine exposure scores compared to men.

Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion.

Our findings suggest sociocultural factors can influence cardiometabolic health measures. Overall, 4 of the 7 metrics examined were worse in the NY population compared to PR. In PR, measures of diet and PA were worse compared to the NY site. While study participants are ethnically homogenous, Puerto Ricans living in NY are considered and ethnic minority while those living in Puerto Rico are the ethnic majority, experiences of discrimination and racism may differ across groups. Furthermore, BYS participants live in distinct social, political, cultural and built environments. Differences between sites based on access to food, recreational facilities and walkability of neighborhoods could explain noted cardiometabolic differences. Similarly social, political, and cultural factors, including economic and political instability, structural racism, adequate health care access and educational and occupational opportunities differ across sites. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease.

https://www.sciencedirect.com/science/article/abs/pii/S1047279723002144

In the United States (U.S.), roughly one in three adults has hypertension, and the burden of hypertension is particularly high among African American populations (African American: 40.3%; White: 27.8%). Existing literature has demonstrated that experiencing stress is positively associated with hypertension. Coping strategies, or how individuals respond to stress, have been hypothesized to explain disparate associations between stress and hypertension.

Whether directly stated or implied, public health has historically tended to focus on behavioral and individual- level explanations for understanding patterns in racial/ethnic or class health inequities. Past research has demonstrated that attributing health disparities to poorer health behaviors (e.g., not following recommended guidelines) and individual-level factors without accounting for the broader social context in which they arise is insufficient and inaccurate in seeking to understand and address disparities.

This research examined the association between avoidant coping (often perceived to be maladaptive, individual-level behavior) and hypertension while assessing potential differences by race. Additionally, we assessed this relationship both with regard to coping responses to discrimination and stress more generally.

We found that avoidant coping in response to the general stress and discrimination was associated with increased hypertension among White respondents and no associations among African American respondents. This research suggests that racial disparities in hypertension may not be attributable to individual-level coping behaviors.

As this paper examined coping in relation to hypertension, we are not suggesting that general stress and discrimination do not impact the cardiovascular health of African Americans. The impacts of stress and discrimination on cardiovascular health are well supported by the literature, which we suggest be a continued area of research.

We recommend further research build on examinations of stress and social context as determinants of hypertension. Our findings call for a nuanced analytic approach that situates findings within broader social contexts that shape both stressors and coping responses when studying relationships between coping and health. To mitigate the impacts of stress on hypertension, we recommend health interventions not only address individual-level behavior change but also address policies that reinforce health disparities at the structural level.

Read the full paper: Batayeh, B., Shelton, R., Factor-Litvak, P. et al. Racial Disparities in Avoidant Coping and Hypertension Among Midlife Adults. J. Racial and Ethnic Health Disparities (2022). https://doi.org/10.1007/s40615-022-01232-7
https://link.springer.com/article/10.1007%2Fs40615-022-01232-7