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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.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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
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“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]
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“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]
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
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“[2] Havranek EP , Mujahid MS , Barr DA , et al.”
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Metadata
- 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
- 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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