Figure 1
Overview of the cardiovascular exposome and its components. SDI: social deprivation index; CVD: cardiovascular disease; NLP: natural language processing: PM2.5: fine particulate matter smaller than 2.5 micrometers in diameter
Table 1
Studies investigating the association between the social environment and cardiovascular outcomes. CDC: Centers for Disease Control and Prevention; ATSDR: Agency for Toxic Substances and Disease Registry; CMS: Centers for Medicare and Medicaid Services; SVI: Social Vulnerability Index; CVD: cardiovascular disease; AMI: acute myocardial infarction; HF: heart failure; IHD: ischemic heart disease; CPR: cardiopulmonary resuscitation
| STUDY | STUDY PLACE/YEAR | DATABASE UTILIZED | INDEX | ASSOCIATION WITHIN THE CARDIOVASCULAR EXPOSOME |
|---|---|---|---|---|
| The Association Between Neighborhood Social Vulnerability and Cardiovascular Health Risk Among Black/African American Women in the InterGEN Study | USA/2021 | InterGEN Study, CDC/ATSDR | SVI | Neighborhood social vulnerability and increased cardiovascular risk factor prevalence among Black women |
| Neighborhood-level Social Vulnerability and Prevalence of Cardiovascular Risk Factors and Coronary Heart Disease | USA/2023 | CDC Behavioral Risk Factor Surveillance System database (BRFSS), CDC/ATSDR | SVI | SVI and increased cardiovascular risk factors and prevalence of coronary heart disease |
| Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States | USA/2022 | CDC WONDER, CDC/ATSDR | SVI | Social vulnerability and increased mortality attributed to comorbid cancer and CVD |
| Impact of the Social Vulnerability Index on Pulmonary Embolism Mortality | USA/2023 | CDC WONDER, CDC/ATSDR | SVI | SVI and disproportionate patterns of pulmonary embolism-related mortality in US counties |
| Impact of social vulnerability on comorbid COVID-19 and acute myocardial infarction mortality in the United States | USA/2023 | CDC WONDER, CDC/ATSDR | SVI | SVI and increased comorbid COVID-19 and AMI mortality |
| Mortality trends, disparities, and social vulnerability in cardiac arrest mortality in the young: A cross-sectional analysis | USA/2024 | CDC WONDER, CDC/ATSDR | SVI | SVI and worse cardiac arrest outcomes in the young |
| Association Between Social Vulnerability Index and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study | USA/2022 | CDC BRFSS, CDC/ATSDR | SVI | SVI and greater self-reported prevalent cardiovascular comorbidities and atherosclerotic cardiovascular disease |
| Social Vulnerability and Premature Cardiovascular Mortality Among US Counties, 2014 to 2018 | USA/2021 | CDC WONDER, CDC/ATSDR | SVI | SVI and increased premature CVD mortality across US counties |
| Social Vulnerability and Cardiovascular-Related Mortality Among Older Adults in the United States | USA/2024 | CDC WONDER, CDC/ATSDR | SVI | SVI and greater CVD-related mortality in older adults |
| Social Vulnerability and Location of Death in Heart Failure in the United States | USA/2023 | CDC WONDER, CDC/ATSDR | SVI | SVI and disparities in trends in location of death in patients with HF |
| Impact of Social Vulnerability and Demographics on Ischemic Heart Disease Mortality in the United States | USA/2023 | CDC WONDER, CDC/ATSDR | SVI | SVI and disparities in IHD mortality |
| Development and Validation of the American Heart Association’s PREVENT Equations | USA/2024 | The Chronic Kidney Disease Prognosis Consortium | Predicting Risk of CVD EVENTs (PREVENT) score, SDI | Risk estimation of total CVD for US adults 30 to 79 years of age without CVD at baseline |
| County-level variation in healthcare coverage and ischemic heart disease mortality | USA/2024 | CDC WONDER, CDC PLACES | Healthcare coverage deficiency | Healthcare coverage deficiency and increased IHD mortality from IHD |
| Association of Environmental Injustice and Cardiovascular Diseases and Risk Factors in the United States | USA/2024 | CDC PLACES, CDC/ATSDR | Environmental Justice Index | Environmental injustice and increased prevalence of CVD risk factors |
| Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest | USA/2024 | Cardiac Arrest Registry to Enhance Survival (CARES) | Redlining | Historical redlining and reduced bystander CPR |
| Influence of social vulnerability index on Medicare beneficiaries’ expenditures upon discharge | USA/2024 | CMS database, CDC/ATSDR | SVI | Social vulnerability and greater healthcare costs among Medicare beneficiaries |
Table 2
Studies investigating the association between the natural environment and cardiovascular (CV) outcomes. CDC: Centers for Disease Control and Prevention; ATSDR: Agency for Toxic Substances and Disease Registry; CABG: coronary artery bypass graft
| STUDY | STUDY PLACE/YEAR | DATABASE UTILIZED | INDEX | ASSOCIATION WITHIN THE CV EXPOSOME |
|---|---|---|---|---|
| Long-term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project | Europe/2014 | European Study of Cohorts for Air Pollution Effects (ESCAPE) | Ambient air pollution | Long-term exposure to airborne pollutants and increasing incidence of acute coronary events |
| Short-Term Exposure to Ambient Air Pollution and Mortality From Myocardial Infarction | China/2021 | National mortality surveillance system in Hubei province | Ambient air pollution | Short-term exposure to air pollution and worse myocardial infarction outcomes |
| Risk of nonaccidental and cardiovascular mortality in relation to long-term exposure to low concentrations of fine particulate matter: a Canadian national-level cohort study | Canada/2012 | 1991–2001 Canadian census mortality | Ambient air pollution | Long-term exposure to ambient PM2.5 and greater cardiovascular mortality |
| Spatiotemporal Trends of Stroke Burden Attributable to Ambient PM2.5 in 204 Countries and Territories, 1990–2019: A Global Analysis | Global/2023 | Global Burden of Disease study 2019 | Ambient air pollution | Ambient PM2.5 exposure and greater stroke burden |
| Disparities in Excess Blood Pressure Across the U.S. Associated With Air Pollution Exceeding WHO Guidelines | USA/2024 | CDC/ATSDR Social Vulnerability Index | Ambient air pollution | Air pollution and racial disparities in excess blood pressure |
| Air Pollution and Adverse Cardiovascular Events After Coronary Artery Bypass Grafting | USA/2024 | VA Surgical Quality Initiative Project (VASQIP) | Ambient air pollution | Increased major adverse cardiovascular events and air pollution after CABG |
| Exposure to ambient air pollution and the incidence of congestive heart failure and acute myocardial infarction: A population-based study of 5.1 million Canadian adults living in Ontario | Canada/2019 | Ontario Population Health and Environment Cohort (ONPHEC) | Ambient air pollution | Air pollution and greater incidence of congestive heart failure and myocardial infarction |
| Long-term exposure to ozone and cardiovascular mortality in China: a nationwide cohort study | China/2022 | China Chronic Disease and Risk Factors Surveillance (CCDRFS) | Ozone | Long-term exposure to ozone and increased cardiovascular mortality |
| Long-Term Exposure to Ozone and Fine Particulate Matter and Risk of Premature Coronary Artery Disease: Results from Genetics of Atherosclerotic Disease Mexican Study | Mexico/2022 | Genetics of Atherosclerotic Disease (GEA) study | Ozone and Fine Particulate Matter | Long-term exposure to ozone and PM2.5 and worse premature coronary artery disease outcomes |
| Association of Blood Lead level with Elevated Blood Pressure in Hypertensive Patients | USA/2021 | NHANES | Lead | Blood lead levels and increased prevalence of hypertension |
| Quantifying lead-attributable cardiovascular disease burden in the United States | USA/2024 | The 2019 Global Burden of Disease Study | Lead | Lead-related cardiovascular burden disparities |
| Outdoor artificial light at night and incident cardiovascular disease in adults: A national cohort study across China | China/2024 | China Health and Retirement Longitudinal Study (CHARLS) | Light pollution | Outdoor artificial light at night and increased risk of cardiovascular disease |
Table 3
Studies investigating the association between the built environment and cardiovascular outcomes.
| STUDY | STUDY PLACE/YEAR | DATABASE UTILIZED | INDEX | ASSOCIATION WITHIN THE CARDIOVASCULAR EXPOSOME |
|---|---|---|---|---|
| Favorable Neighborhood Walkability is Associated With Lower Burden of Cardiovascular Risk Factors Among Patients Within an Integrated Health System: The Houston Methodist Learning Health System Outpatient Registry | USA/2023 | Houston Methodist Learning Health System Outpatient Registry | Walkability | Reduced neighborhood walkability and increased cardiovascular risk factors |
| Interaction between neighborhood walkability and traffic-related air pollution on hypertension and diabetes: The CANHEART cohort | Canada/2019 | CANHEART cohort | Walkability | Reduced walkability and increased traffic-related air pollution and greater cardiovascular risk factor prevalence |
| Greenspace seems protective of both high and low blood pressure among residents of an Alpine valley | Austria/2018 | Environmental Health Impact Assessment | Greenspace | Residential greenspace and disparities in abnormal blood pressures |
| Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomized controlled trial | Spain/2022 | CORDIOPREV | Mediterranean diet, low-fat diet | Effectiveness of the Mediterranean and low-fat diet on secondary cardiovascular prevention |
| Food Insecurity Is Associated With Cardiovascular and All-Cause Mortality Among Adults in the United States | USA/2020 | US National Health and Nutrition Examination Survey | Food insecurity | Adult food insecurity and worse cardiovascular disease outcomes |
| Food Environment Quality and Cardiovascular Disease Mortality in the United States: a County-Level Analysis from 2017 to 2019 | USA/2024 | CDC WONDER, County Health Rankings compilation | Food environment index | Food environment quality and greater cardiovascular mortality burden |