Methods proven to prevent ASCVD may fall short in certain populations if the impacts of SDOH are not closely monitored. The ACC/AHA provide considerations for 7 health domains.
Research demonstrates that socioeconomic inequalities are "strong determinants" of cardiovascular risk throughout the world.
Members of the writing committee for the American College of Cardiology/American Heart Association 2019 Guideline on Primary Prevention of Cardiovascular Disease incorporated throughout the guideline consideration of how social determinants of health may impact the efficacy of specific guidance and prescriptions for an individual patient. ACC/AHA recommends that clinicians revisit these considerations at each follow-up visit.
Considerations include but are not limited to socioeconomic and educational status as well as cultural, home, and employment environments. The slides below highlight the ACC/AHA considerations for 7 health domains.
CARDIOVASCULAR RISK. Adults should be routinely assessed for psychosocial stressors and provided with appropriate counseling. Health literacy should be assessed every 4 to 6 yrs to maximize recommendation effectiveness.
DIET. In addition to the prescription of diet modifications, body size perception, as well as social and cultural influences, should be assessed.
BARRIERS TO HEALTHY EATING. Potential barriers to adhering to a heart-healthy diet should be assessed, including food access and economic factors. These factors may be particularly relevant to persons from vulnerable populations, such as individuals residing in either inner-city or rural environments, those at socioeconomic disadvantage, and those of advanced age.
ACCESS: EXERCISE, PHYSICAL ACTIVITY. In addition to the prescription of exercise, neighborhood environment and access to facilities for physical activity should be assessed.
OBESITY, WEIGHT LOSS. Lifestyle counseling for weight loss should include assessment of and interventional recommendations for psychosocial stressors, sleep hygiene, and other individualized barriers. In patients unable to achieve recommended weight loss, promote weight maintenance.
DIABETES MELLITUS. In addition to the prescription of type 2 diabetes mellitus interventions, environmental and psychosocial factors should be assessed to improve achievement of glycemic control and adherence to treatment. Factor include/are not limited to depression, stress, self-efficacy, social support.
ELEVATED BLOOD PRESSURE. Short sleep duration (<6 h) and poor-quality sleep are associated with high blood pressure and should be considered. Because other lifestyle habits can impact blood pressure, access to a healthy, low-sodium diet and viable exercise options should also be considered.