Social determinants of cardiovascular health: From prevention to care and emerging challenges

Cardiovascular disease (CVD) is the leading cause of mortality globally and imposes a substantial disease burden. Addressing the social determinants of health (SDOH) presents a critical opportunity to reduce CVD-related mortality and disability. In Japan, CVD constitutes a major cause of death and necessitates long-term care, with current guidelines now incorporating SDOH related to CVD, indicative of a growing interest in these determinants. This review outlines the definition and conceptual frameworks of SDOH, along with its key domains: (1) Economic stability, (2) Education access and quality, (3) Social and community context, (4) Health care access and quality, and (5) Neighborhood and built environment. In addition to these established determinants, we discuss emerging SDOH such as climate change and digital health technologies, which may reshape cardiovascular risk and potentially widen existing disparities. We also summarize existing epidemiological findings and implications for intervention strategies, and outline future perspectives, including the implications of genetic testing and related ethical, legal, and social issues, as well as strategies aimed at reducing health disparities. Overall, advancing equitable cardiovascular health will require continued research, greater recognition of the role of SDOH, and efforts to address these determinants, including improving understanding of SDOH among health care professionals and the public and strengthening the evidence base for CVD and SDOH.