A study of 1,171 adults found that people living in lower-income neighborhoods have significantly greater coronary atherosclerosis, with those in areas earning under $50,000 having about twice the risk of obstructive coronary artery disease compared to those in areas earning $150,000 or more, suggesting that socioeconomic context should be integrated into cardiovascular risk prediction tools.
- Study population: 1,171 adults aged 40-79 who underwent coronary CT angiography (CCTA) from 2015 to 2024
- Key finding: Lower neighborhood income independently associated with higher atherosclerotic cardiovascular disease risk and greater coronary artery calcium burden
- Risk disparity: Those in areas with median income under $50,000 had approximately twofold higher odds of obstructive coronary artery disease versus those in areas with income $150,000 or higher
- Proposed mechanisms: Material deprivation limiting preventive care access, chronic psychosocial stress, environmental exposures (air pollution, noise), and reduced access to green space
- Recommendation: Integration of validated socioeconomic measures into cardiovascular risk prediction tools to enhance calibration and promote equitable allocation of imaging and preventive therapies
Coronary CT angiography (CCTA) scans reveal that lower neighborhood income is linked to greater coronary atherosclerosis, a team at the University of California Davis in Sacramento has reported.
The finding is from a cross-sectional analysis of 1,171 adults between 40 and 79 years old who underwent CCTA from 2015 to 2024, with results suggesting that socioeconomic context may improve cardiovascular risk prediction, noted lead author Mehrad Rokni, MD, and colleagues.
“Integration of validated socioeconomic measures into cardiovascular risk prediction tools may enhance calibration and promote more equitable allocation of imaging and preventive therapies,” the group wrote. The study was published September 13 in The American Journal of Medicine.
Large population-based studies have consistently demonstrated that lower socioeconomic status, measured by income, education, or occupation, is independently associated with increased risk of coronary heart disease and premature cardiovascular death, even after adjustment for traditional risk factors, the authors explained. Yet the relationship between socioeconomic disparities and imaging-defined coronary atherosclerosis on CCTA is not fully understood, and the researchers sought to address this gap.
Primary outcomes of the study were coronary artery calcium and obstructive coronary artery disease, defined as a Coronary Artery Disease-Reporting and Data System (CAD-RADS) score of 3 or greater; 10-year atherosclerotic cardiovascular disease (ASCVD) risk category served as a secondary comparator. The primary exposure was census tract-level median household income.
Among the 1,171 participants, lower household income was independently associated with higher ASCVD risk category and greater imaging-defined atherosclerotic burden. Compared with individuals residing in census tracts with median income ≥ $150,000, those in areas with income <$50,000 had approximately twofold higher odds of obstructive coronary artery disease after full adjustment, the researchers reported.
“In this contemporary CCTA study, lower income was independently associated with worse ASCVD category, higher coronary artery calcium burden, and greater odds of obstructive coronary artery disease,” the group wrote.
The authors suggested that the observed findings likely reflect multiple, interacting mechanisms operating across the life course. For instance, material deprivation may limit access to preventive care, medications, and cardioprotective nutrition, while chronic psychosocial stress related to financial insecurity may promote neuroendocrine activation and inflammatory pathways that accelerate atherosclerosis. Also, environmental exposures, including air pollution, noise, and limited access to green space, may further compound cumulative vascular injury, they wrote.
Ultimately, validation of the results are warranted in larger and more socioeconomically diverse, multicenter cohorts, they added, noting that substantial socioeconomic heterogeneity across U.S. regions and other high-income settings may give the findings broader relevance beyond a single academic center.
The full study is available here.
