Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association
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The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a
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SDOH, the nonmedical risk factors impacting disease risk and health outcomes, play a critical role in CKM health across the life course.
“SDOH, the nonmedical risk factors impacting disease risk and health outcomes, play a critical role in CKM health across the life course.11–14”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The Life-Course Context of SEP section links early-life socioeconomic conditions to adult cardiovascular disease and its risk factors. The paper also discusses type 2 diabetes and metabolic risk, but the cited passages do not establish the broader claim about cardiovascular-kidney-metabolic (CKM) health, particularly kidney health, across the life course. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThis may be especially true in younger adults with CKM syndrome with accelerated CAC development due to multiple interrelated risk factors with high long-term CVD risk, indicating the need to start risk factor management early in the course of CKM syndrome.
“This may be especially true in younger adults with CKM syndrome with accelerated CAC development due to multiple interrelated risk factors with high long-term CVD risk, indicating the need to start risk factor management early in the course of CKM syndrome.12–16”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredImplicit bias may lead physicians to provide dissimilar lower quality treatment to patients of marginalized groups, low-value clinical interactions between physician and minority patients, and stereotype threat where patients avoid medical care out of the fear of being racially stereotyped, all contributing to racial disparities in healthcare.
“Furthermore, implicit bias may lead physicians to provide dissimilar lower quality treatment to patients of marginalized groups, low-value clinical interactions between physician and minority patients, and stereotype threat where patients avoid medical care out of the fear of being racially stereotyped, all contributing to racial disparities in healthcare.41,47”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [41]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredDisparities among housing, income, education level, and access to quality health care disadvantage underserved populations, and these populations are much more likely to be Black or Hispanic.
“Disparities among housing, income, education level, and access to quality health care disadvantage underserved populations, and these populations are much more likely to be Black or Hispanic.41”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [41]
The sections on socioeconomic disadvantage and race/ethnicity link income and education to cardiovascular risk and describe racial differences in healthcare experiences. The allostatic-load section also notes lower average educational and occupational attainment among Black adults. But the cited passages do not establish that underserved populations facing the listed housing, income, education, and healthcare disparities are much more likely to be Black or Hispanic; the paper describes the picture for Latinos as more complex. Page numbers were not available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredStressful life events, chronic daily stressors, and high levels of perceived stress affect CVD health.
“Stressful life events, chronic daily stressors, and high levels of perceived stress have been shown to affect CVD health. 14”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [14]
The Psychological Mechanisms section reports an association between perceived stress and CVD risk, while the Allostatic Load section describes cardiovascular harm from persistent stress. The passages do not establish the claimed effect of stressful life events specifically, and the paper cautions that evidence for more general measures of stress is less consistent. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Ultimately, adverse SDOH have downstream consequences on cardiovascular and all-cause mortality and contribute to disparities in CVD mortality.
“Ultimately, adverse SDOH have downstream consequences on cardiovascular and all-cause mortality11,14 and contribute to disparities in CVD mortality.21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
Individuals who exhibit chronically elevated stress hormones and inflammatory biomarkers have been shown to have a higher risk of subsequent coronary artery disease.
“Individuals who exhibit chronically elevated stress hormones and inflammatory biomarkers as a result have been shown to have a higher risk of subsequent coronary artery disease.”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [41]
Estimated GFR using both creatinine and cystatin C provides better accuracy than eGFR using either marker alone; however, the availability of cystatin C measurement is limited.
“Estimated GFR using both creatinine and cystatin C provides better accuracy than eGFR using either marker alone; however, the availability of cystatin C measurement is limited.14”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The paper’s sections on CVD risk prediction and biomarkers discuss socioeconomic position and other markers, not eGFR estimation. Searches for cystatin C, creatinine, and glomerular filtration rate found no passage comparing their accuracy or addressing the availability of cystatin C measurement; the copy is not truncated. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIndividuals with obesity have a greater likelihood of successfully achieving >10% weight loss after a nonjudgmental weight loss discussion compared to one perceived as judgmental.
“Studies demonstrate that individuals with obesity have a greater likelihood of successfully achieving >10% weight loss after a nonjudgmental weight loss discussion compared to one that is perceived as judgmental.14”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The Behavioral Mechanisms section discusses obesity and health behaviors, while the References list weight-loss studies, but neither addresses how a weight-loss discussion is perceived. Searches for judgmental versus nonjudgmental discussions and for the >10% weight-loss threshold found no passage reporting the claimed comparison. (LLM, conf=0.76)
Experimental — accuracy not yet measuredBupropion/naltrexone, phentermine/topiramate, and orlistat have shown efficacy in improving glycemia, and phentermine/topiramate and orlistat in reducing BP.
“Bupropion/naltrexone, phentermine/topiramate, and orlistat have all shown efficacy in improving glycemia, and the latter 2, in reducing BP.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The Behavioral Mechanisms section discusses how weight loss and changes in health behaviors relate to diabetes and hypertension risk, but it does not evaluate these drugs. Searches for bupropion/naltrexone, phentermine/topiramate, orlistat, glycemia, and blood-pressure effects found no passage addressing the claimed drug-specific efficacy; page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredMBS has been shown to be superior overall in promoting long-term weight loss and reducing cardiovascular risks, morbidity, and mortality.
“MBS has, to date, been shown to be superior overall in promoting long-term weight loss and reducing cardiovascular risks, morbidity, and mortality, though this may change as evidence for the benefits of GLP-1 accumulates.14–16”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The Behavioral Mechanisms section discusses weight loss and cardiovascular risk in general, but does not address metabolic and bariatric surgery (MBS). Searches for bariatric surgery and comparisons with GLP-1 treatment found no passage establishing MBS’s superiority for long-term weight loss, cardiovascular outcomes, morbidity, or mortality. Page numbers were not available in the indexed copy. (LLM, conf=0.75)
Experimental — accuracy not yet measuredBoth SGLT2i and GLP-1-based therapy confer cardiovascular benefits independent of metformin.
“Both SGLT2i and GLP-1– based therapy confer cardiovascular benefits independent of metformin and should be first-line therapeutic considerations.14,15”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The Behavioral Mechanisms and Future Directions sections discuss cardiovascular risk and diabetes care, but do not address the cardiovascular effects of SGLT2 inhibitors or GLP-1–based therapy. Searches for those therapies, metformin, and first-line treatment found no passage assessing benefits independent of metformin. Page numbers were not available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredHFpEF is more strongly epidemiologically linked to obesity than HFrEF, and there are now completed clinical trials of obesity treatment in HFpEF.
“This is particularly evident in HFpEF, which is more strongly epidemiologically linked to obesity than HFrEF, and in which there are now completed clinical trials of obesity treatment.13,14”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The paper’s introductory discussion links rising cardiovascular disease burden to obesity, but does not compare obesity’s association with HFpEF and HFrEF. Searches for those heart-failure subtypes and for completed obesity-treatment trials in HFpEF found no passage addressing either claim; the nearby References passages concern other topics. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSubgroup analyses in both studies specifically examined individuals with diabetes at baseline.
“Subgroup analyses in both studies specifically examined individuals with diabetes at baseline.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The Socioeconomic Disadvantage and Risk Factors for CVD section (page unavailable) mentions diabetes in a study of people without CVD at baseline, but does not describe subgroup analyses of people with diabetes at baseline. Searches for the claimed subgroup analyses and baseline diabetes found no passage addressing whether both studies performed them. (LLM, conf=0.76)
Experimental — accuracy not yet measuredOne study found that the addition of SGLT2i therapy resulted in incremental quality-adjusted survival of 0.70 (95% UI, 0.23-1.20) QALYs, at an incremental cost of $46,500 (95% UI, $32,700-$49,700), producing an incremental cost-effectiveness ratio of $66,800 (95% UI, $53,800-$116,600) per QALY gained and making it a cost-effective strategy in 95% of 10,000 probabilistic simulations.
“One study found that the addition of SGLT2i therapy resulted in incremental quality-adjusted survival of 0.70 (95% uncertainty interval [UI], 0.23–1.20) QALYs, at an incremental cost of $46 500 (95% UI, $32 700–$49 700), producing an incremental cost-effectiveness ratio of $66 800 (95% UI, $53 800–$116 600) per QALY gained and making it a cost-effective strategy in 95% of 10 000 probabilistic”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredTwo high-quality simulation model-based cost-effectiveness analyses evaluated the economic value of adding SGLT2i therapy to prior GDMT in adults with symptomatic HFrEF, from a US health care sector perspective and a lifetime analytic horizon.
“Two high-quality simulation model–based cost-effectiveness analyses evaluated the economic value of adding SGLT2i therapy to prior GDMT in adults with symptomatic HFrEF, from a US health care sector perspective and a lifetime analytic horizon.14,15”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe study also reported incremental cost-effectiveness ratios of $57,300 (95% UI, $44,800-$123,800) per life year gained and $53,400 (95% UI, $42,800-$97,200) per equal value of life-years gained.
“The study also reported incremental cost-effectiveness ratios of $57 300 (95% UI, $44 800–$123 800) per life year gained and $53 400 (95% UI, $42 800–$97 200) per equal value of life-years gained.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The Affordability section discusses healthcare costs and access, but does not report incremental cost-effectiveness ratios. Searches of our copy for both dollar amounts, “equal value of life-years gained,” and “incremental cost-effectiveness ratio” found no passage addressing the claimed estimates; no page number was available for the indexed passages. (LLM, conf=0.75)
Experimental — accuracy not yet measuredData from meta-analyses and pooled studies demonstrate that individuals at highest risk for MASLD and its progression include those with T2D and/or those with more than 2 cardiometabolic risk factors such as obesity, hyperlipidemia, or hypertension.
“Data from meta-analyses and pooled studies demonstrate that individuals at highest risk for MASLD and its progression include those with T2D and/or those with more than 2 cardiometabolic risk factors such as obesity, hyperlipidemia, or hypertension.14,28–30”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The 'Socioeconomic Disadvantage and Risk Factors for CVD' and 'Behavioral Mechanisms' sections discuss diabetes, obesity, hypertension, and lipid abnormalities as cardiovascular risk factors, not as predictors of MASLD. Searches for MASLD and nonalcoholic fatty liver disease found no passage addressing MASLD risk or progression, including the claimed threshold of more than two cardiometabolic risk factors. (LLM, conf=0.76)
Experimental — accuracy not yet measuredNovel oral potassium binding agents such as patiromer may allow for improved use of RAAS inhibition across eGFR by lowering risk of hyperkalemia, although few patients with eGFR <30 mL/min/1.73 m2 have been included in prior trials with co-existing HF.
“Novel oral potassium binding agents such as patiromer may allow for improved use of RAAS inhibition across eGFR by lowering risk of hyperkalemia, although few patients with eGFR <30 mL/min/1.73 m2 have been included in prior trials with co-existing HF.14,15,45”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredMASLD is a highly prevalent, chronic, progressive, and life-threatening disease.
“MASLD, formally nonalcoholic fatty liver disease, is a highly prevalent, chronic, progressive, and life-threatening disease.12–14”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The paper's Abstract discusses cardiovascular disease mortality, and its section on prenatal and early-childhood deprivation mentions liver insulin signaling, not fatty liver disease. Searches for MASLD and nonalcoholic fatty liver disease found no passage addressing whether MASLD is prevalent, chronic, progressive, or life-threatening. (LLM, conf=0.76)
Experimental — accuracy not yet measuredRandomized trials of CPAP versus usual care failed to demonstrate reductions in mortality, cardiovascular events, or kidney events.
“randomized trials of CPAP versus usual care failed to demonstrate reductions in mortality, cardiovascular events, or kidney events.11–14”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The passages from the Social Support and Future Directions sections discuss other interventions, not CPAP. Searches of our full-text copy for CPAP, usual-care comparisons, and kidney outcomes found no passage addressing the claimed randomized-trial results; the cited paper therefore cannot verify this claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredLarger declines in eGFR are more common in those with low eGFR, HF, prior AKI, and diuretic use.
“Larger declines in eGFR are more common in those with low eGFR, HF, prior AKI, and diuretic use,13,14,45”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The closest kidney-related passage, in “Effect of Prenatal/Early Childhood Deprivation on CVD Incidence in Adulthood” (page unavailable), discusses fewer nephrons and later kidney disease, not eGFR declines. Searches for eGFR, prior AKI, and diuretic use found no passage linking those factors—or heart failure—to larger eGFR declines. (LLM, conf=0.76)
Experimental — accuracy not yet measuredNaltrexone/bupropion 32 mg/360 mg produces an average maximal placebo-corrected weight loss of 4% and a maximal weight loss of 8% over 56 weeks.
“4% 8% 56”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The retrieved References passages mention weight-loss studies, and the Residential Environments passage discusses BMI outcomes, but neither addresses naltrexone/bupropion. Searches for the drug and dose, and for the 4%, 8%, and 56-week figures, found no passage supporting the claimed results. (LLM, conf=0.75)
Experimental — accuracy not yet measuredFamily history of diabetes or kidney failure is a risk enhancer for CKM syndrome.
“Family history14 Diabetes”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The section on prenatal and early-childhood deprivation discusses links between poor fetal growth, kidney disease, and type 2 diabetes, but not family history as a risk enhancer. Searches for family history, kidney failure, and CKM syndrome found no passage in our copy addressing the attributed claim. Page numbers were unavailable. (LLM, conf=0.72)
Experimental — accuracy not yet measuredSGLT2i-induced decreases in eGFR up to 30% are not associated with adverse outcomes.
“SGLT2i-induced decreases in eGFR up to 30% are not associated with adverse outcomes.13,14”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [14]
The supplied passages concern social determinants of cardiovascular disease, and the searched passages from the References and prenatal/early-childhood deprivation sections do not address SGLT2 inhibitors or treatment-related eGFR changes. Searches for the quoted claim and for a 30% decline in estimated glomerular filtration rate found no passage assessing adverse outcomes. (LLM, conf=0.78)
Experimental — accuracy not yet measured
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- Authors
- Havranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., Davey-Smith, G., Dennison-Himmelfarb, C. R., Lauer, M. S., Lockwood, D. W., Rosal, M., & Yancy, C. W.
- ORCID
- Venue
- Circulation
- Published
- 2015-09
- Volume
- 132
- Issue
- 9
- Pages
- 873-898
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1939947548
- Semantic Scholar
- 779c55cd0fbe99556264e4754bf36925902caa68
- Cited by
- 1,472
- References
- 346
- Citations by year
- 2026: 125 · 2025: 167 · 2024: 157 · 2023: 191 · 2022: 192 · 2021: 198 · 2020: 141 · 2019: 94 · 2018: 83 · 2017: 68 · 2016: 47 · 2015: 7 · 2012: 1
- FWCI
- 84.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- social determinants of health, cardiovascular disease, cardiovascular risk, cardiovascular outcomes
- MeSH terms
- American Heart Association, Cardiovascular Diseases, Humans, Hypertension, Obesity, Risk Factors, United States, Treatment Outcome, Social Determinants of Health
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