Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions

Abstract

Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.

Keywords: aerobic exercise; aging biology; disparities; social determinants; vascular function.

Graphical abstract

Figure 1.

Traditional and nontraditional risk factors for cardiovascular disease (CVD). Both traditional (modifiable and nonmodifiable) and nontraditional (vascular endothelial dysfunction and arterial stiffness) risk factors contribute to CVD risk. NO, nitric oxide.

Figure 2.

Mechanisms of arterial dysfunction. Chronological aging leads to the accumulation of adverse fundamental aging processes. In turn, these processes drive arterial dysfunction to increase the risk of cardiovascular disease (CVD). NO, nitric oxide.

Figure 3.

Social determinants of cardiovascular health. Socioeconomic status can be viewed as the primary overarching determinant and the main driver of other social determinants of health, including environmental factors (green spaces, neighborhood, and pollution); psychosocial factors (stress, family, social network, and social exclusion); and healthcare access and education.

Figure 4.

Barriers to aerobic exercise. Marginalized racial and ethnic groups disproportionately experience barriers that hinder their ability to meet aerobic exercise guidelines aimed at improving cardiovascular (CV) health. These factors independently create obstacles to achieving optimal CV health, however, when experienced concurrently these barriers may be insurmountable.

Figure 5.

Alternative strategies to overcome barriers to aerobic exercise to improve arterial function. Such approaches include lifestyle interventions, pharmacological supplementation, culturally appropriate activities, and/or other community-based health education practices and have been shown to target fundamental aging processes and improve some measures of arterial function with aging. Importantly, these alternative strategies may overcome some or all of the barriers to aerobic exercise often experienced by marginalized racial and ethnic groups.

Figure 6.

Research gaps and future directions. Presented are important research gaps in understanding accelerated arterial dysfunction in marginalized racial and ethnic groups. These research gaps need prioritization in ongoing and future studies. CVD, cardiovascular disease; NO, nitric oxide.