Social context predicts heart risks despite normal biomarkers
Below target cutoffs, participants with less favorable social context had cardiovascular event rates of 3.39 versus 1.68, 7.16 versus 2.05, and 8.67 versus 2.34 per 1,000 person-years.
medRxiv
In an observational study of adult participants in the All of Us Research Program, researchers evaluated whether social context influenced cardiovascular risk even when standard biomarkers appeared controlled. They analyzed three cohorts without prior cardiovascular disease or high comorbidity: systolic blood pressure (19,525 participants), LDL cholesterol (16,578 participants), and A1c (18,539 participants). A preindex score combined household income, education, food security, physical activity, and neighborhood deprivation. Each one-standard-deviation more favorable score was associated with a lower hazard of myocardial infarction, ischemic stroke, or heart failure: hazard ratios were 0.611 for blood pressure, 0.631 for LDL, and 0.544 for A1c cohorts. Even among individuals meeting clinical cutoffs—systolic blood pressure below 140 mmHg, LDL below 100 mg/dL, and A1c below 8%—less favorable social context separated those who experienced subsequent cardiovascular events.
Why it matters
Cardiovascular conditions remain leading drivers of age-related morbidity and mortality. The findings show that measuring clinical biomarkers alone may overlook how cumulative socioeconomic and environmental exposures shape cardiovascular vulnerability over the lifespan.
Caveats
This study is a preprint that has not yet been peer-reviewed. The observational and retrospective design also prevents establishing direct causal relationships between social factors and cardiovascular outcomes.
The paper
UC Davis Health
medRxiv · 30 Sep 2026 · Preprint, not peer-reviewed