AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Lower Socioeconomic Status Increases Cardiovascular Risk by Accelerating the Development of Cardiometabolic Risk Factors
By Torpoco Rivera M, Saeed F, Otobo E et al.
Introduction: Lower socioeconomic status (SES) is strongly associated with greater incidence of major adverse cardiovascular events (MACE). However, the mechanisms linking low SES to MACE remain incompletely understood. Research Question: We investigated whether: 1) lower SES is associated with accelerated gains in cardiometabolic risk factors (CMRFs) independently of lifestyle factors, and 2) whether that accelerated CMRF gain, in turn, contributes to increased MACE risk. Methods: Participants without prior MACE and with available SES and CMRF data were identified in the Mass General Brigham Biobank. SES was assessed using education level (categorized as no college, some college, 4-year undergraduate degree, and graduate degree), median neighborhood income, and area deprivation index (ADI), with income and ADI analyzed as continuous variables. CMRFs were defined as hypertension, hyperlipidemia, and diabetes mellitus using ICD codes. Incident CMRFs and the time to develop them were measured over 10 years of follow-up. Models assessing the relationship between SES and incident CMRFs were adjusted for age, sex, smoking, and baseline CMRFs (primary model). Additional models also adjusted for obesity (using ICD codes) and lifestyle factors, including insomnia (using ICD codes), physical activity (categorized as ≥150 vs. <150 minutes of moderate-intensity activity/week), and alcohol intake (number of drinks per week). Results: Among 105,764 participants with available data, all SES measures were independently associated with heightened risk of developing a new CMRF. In the primary model, the hazard ratio (HR) for development of a new CMRF was 0.889 (95% confidence interval (CI) 0.875-0.902) for higher education, 0.945 (0.935-0.955) for higher income, and 1.034 (1.029-1.039) for higher ADI (all p<0.001). Notably, these associations generally persisted after additional adjustment for lifestyle factors (Table 1). Furthermore, development of ≥1 new CMRF was independently associated with higher incident MACE risk (odds ratio (OR) 1.307, 95% CI 1.269-1.345; p<0.001). There was a graded association between education level and time to development of a new CMRF (log-rank p<0.001; Figure 1) with similar findings for quartiles of neighborhood income and ADI (log-rank p<0.001). Mediation analyses showed that accelerated CMRF acquisition partially explained the relationship between SES and incident MACE, accounting for 13-16% of the total effect (Figure 2). Conclusion: These findings suggest that among individuals with lower SES, the acquisition of CMRFs is accelerated and is not explained by lifestyle factors. Moreover, this development of CMRFs mediates the increased risk of incident MACE. Accordingly, closer monitoring for new CMRFs is warranted among individuals with lower SES.