Imaging Findings Associated With Socioenvironmental Exposures Inform Mechanisms of Cardiovascular Disease

Cardiovascular disease remains the leading cause of mortality worldwide, driven by risk factors that range from traditional (eg, hypertension, hyperlipidemia) to less recognized socioenvironmental contributors. These broader exposures include adverse socioeconomic status, air and noise pollution, attributes of the built environment, and ambient temperatures, among others, which exert complex mechanistic influences that often involve neural-autonomic-immune pathways that promote traditional cardiovascular disease risk factors and atherosclerosis. Advanced noninvasive imaging modalities, including positron emission tomography, computed tomography, magnetic resonance imaging, and ultrasound, allow for assessment of subclinical vascular changes, such as arterial inflammation and plaque burden, as well as assessments of changes in other organs, including the brain and inflammatory tissues, that associate with these exposures and have the potential to clarify the mechanisms of exposure-related pathology. This review synthesizes current evidence from multimodality imaging studies linking socioeconomic status, air pollution, noise, and other environmental exposures to imaging markers of cardiovascular disease. These findings suggest opportunities to deeply characterize underlying mechanisms, refine risk assessment, prioritize targeted interventions, and inform policies aimed at mitigating adverse exposures. Through this framework, we aim to catalyze a broader approach to preventing cardiovascular disease that recognizes the profound interplay among the social, environmental, and biological determinants of health.