In the United States, two out of every five adults have obesity. The obesity epidemic is a significant public health concern and a major risk factor for atherosclerotic cardiovascular disease (ASCVD), contributing to its development through a complex interplay of social, biologic and behavioral mechanisms. It exacerbates traditional cardiovascular risk factors such as dyslipidemia, hypertension, and type 2 diabetes, while visceral and epicardial fat deposition promotes inflammation and insulin resistance, thereby accelerating atherosclerosis. Beyond traditional pathophysiologic pathways, social determinants of health (SDoH) significantly contribute to obesity-related disparities, particularly among racial and ethnic minorities. SDoH factors such as socioeconomic status, access to health care, and limited availability of nutritious food and safe spaces for physical activity not only increase obesity prevalence but also exacerbate its psychological toll, including stress and anxiety, which further elevate cardiovascular risk. Environmental factors, such as limited green spaces and air pollution, further promote obesogenic behaviors and worsen cardiovascular outcomes. In this review, we explore the association between obesity and ASCVD and key mediating pathways including the role of SDoH and environmental risk factors. We also discuss potential strategies—including patient education, community engagement to address SDoH, and establishment of dedicated cardiometabolic and cardiovascular prevention clinics—to mitigate the population burden of obesity and improve downstream cardiovascular outcomes.

Introduction: Understanding the role of social determinants of health as predictors of mortality in adults with diabetes may help improve health outcomes in this high-risk population. Using population-based, nationally representative data, this study investigated the cumulative effect of unfavorable social determinants on all-cause mortality in adults with diabetes. Research design and methods: We used data from the 2013–2018 National Health Interview Survey, linked to the National Death Index through 2019, for mortality ascertainment. A total of 47 individual social determinants of health were used to categorize participants in quartiles denoting increasing levels of social disadvantage. Poisson regression was used to report age-adjusted mortality rates across increasing social burden. Multivariable Cox proportional hazards models were used to assess the association between cumulative social disadvantage and all-cause mortality in adults with diabetes, adjusting for traditional risk factors. Results: The final sample comprised 182 445 adults, of whom 20 079 had diabetes. In the diabetes population, mortality rate increased from 1052.7 per 100 000 person-years in the first quartile (Q1) to 2073.1 in the fourth quartile (Q4). In multivariable models, individuals in Q4 experienced up to twofold higher mortality risk relative to those in Q1. This effect was observed similarly across gender and racial/ethnic subgroups, although with a relatively stronger association for non-Hispanic white participants compared with non-Hispanic black and Hispanic subpopulations. Conclusions: Cumulative social disadvantage in individuals with diabetes is associated with over twofold higher risk of mortality, independent of established risk factors. Our findings call for action to screen for unfavorable social determinants and design novel interventions to mitigate the risk of mortality in this high-risk population.

The relationship between psychological health and cardiovascular health (CVH) during pregnancy is not well characterized. The purpose of this study was to perform a cross-sectional analysis in order to assess the relationships between psychological distress and CVH among pregnant individuals in the United States. U.S. National Health Interview Survey (2013-2018) data were used for the analyses. The sample included all pregnant participants aged ≥18 years, but excluded those with missing data for the exposure, outcome, or covariates. Psychological health was measured with the 6-item Kessler scale, and severe psychological distress was defined as 6-item Kessler scale ≥13. CVH was quantified using the American Heart Association's Life's Essential 8; as detailed dietary data were unavailable, a 7-item score was used (higher scores indicated worse CVH). Multivariable Poisson regression tested associations between severe psychological distress and CVH, adjusting for potential confounders including age, race/ethnicity, sexual orientation, education level, family income, any known cardiovascular conditions, and insurance. Among 1,110 pregnant individuals (representing >1.5 million pregnant individuals each year of the survey), 3.5% reported severe psychological distress (95% CI: 2.2%-5.5%), 21.7% reported moderate psychological distress (95% CI: 18.8%-24.9%), and 74.9% reported either mild or no psychological distress (95% CI: 71.4%-78.0%). Individuals reporting moderate psychological distress (adjusted rate ratio: 1.25 [95% CI: 1.13-1.38], P < 0.001) or severe psychological distress (adjusted rate ratio: 1.42 [95% CI: 1.20-1.68], P < 0.001) had lower CVH scores compared to those with mild or no psychological distress. A stepwise relation was observed between the severity of psychological distress and CVH. We observed a strong association between psychological distress and suboptimal CVH during pregnancy, highlighting the need to manage psychological health along with CVH in pregnant individuals.