Sarcouncil Journal of Applied Sciences Aims & Scope

Abstract: Cardiovascular disease (CVD) is a prominent contributor to morbidity and mortality within the United States, a result of complex interactions between genetic predisposition and patterned exposure within a social environment. Despite the improved ability to detect genetic risk for cardiometabolic phenotypes and CVD using advances within the field of genomics, these risks are not equally expressed or distributed within socioeconomic environments. This review integrates evidence from genetic epidemiology, social epidemiology, and the field of cardiovascular disease to critically evaluate how socioeconomic adversity modifies genetic risk via metabolic intermediate phenotypes, such as obesity, insulin resistance, dyslipidemia, and hypertension. Through a model of socioeconomic adversity that spans levels of analysis, from the individual to the structural, exposure to chronic stress, the obesogenic environment, access to health care, as well as cumulative physiological exposure, can be shaped, thereby potentiating cardiometabolic risk for genetically predisposed individuals. Studies using polygenic risk scores further illustrate that genetic risk can be improved by accounting for contextual factors, suggesting that genetically deterministic models of CVD may be overly simplistic. This review proposes that socioeconomic adversity, as a contextual element, be incorporated within models of interaction between genes and the environment, providing a means for improved etiologic understanding, risk stratification, and reduced health disparities for cardiovascular disease within a life course- and equity-focused approach for cardiovascular genomics that may provide a more realistic, as well as a responsive, means for translating genetic discoveries within the field for their ultimate use within a public health context.