What your zip code may reveal about your future heart health
Where a person lives can have a greater impact on their future heart health than previously
understood. A new study co-led by Kai Zhang, PhD, professor in the Department of Public Health at UNT Health Fort Worth, found that
neighborhood social determinants of health in early adulthood are associated with
an increased risk of developing subclinical cardiovascular disease later in life.
The findings highlight poverty, education, employment, healthy food access, physical
activity resources and neighborhood safety as influences of long-term health outcomes.
Published in the highly recommended journal Nature Communications, the study analyzed data from nearly 3,500 participants enrolled in the long-running Coronary Artery Risk Development in Young Adults (CARDIA) study. Researchers developed a novel neighborhood Social Determinant of Health Index that combined multiple community-level factors to better understand their cumulative effect on cardiovascular disease risk.
“Health is shaped by much more than individual choices,” Zhang said. “The environments where people live, work and grow can create opportunities for health or barriers that accumulate over time. Understanding those neighborhood influences is critical for preventing disease before it develops.”
Recently, Zhang was named a standing member of the National Institutes of Health's Social and Environmental Determinants of Health (SEDH) Study Section for a three-year term that spans July 2026 through June 2029. The appointment is considered a significant professional distinction at the national level. Those appointed are recognized experts who help evaluate and guide federally funded research focused on how social and environmental factors influence health outcomes.
Researchers examined participants from young adulthood into middle age and assessed the presence of coronary artery calcification, an early marker of atherosclerosis and future cardiovascular disease. The study found that individuals who lived in neighborhoods with more adverse social and economic conditions had a significantly higher likelihood of developing coronary artery calcification (an indicator of subclinical cardiovascular diseases) decades later, even after accounting for personal health behaviors and other risk factors.
The findings underscore the importance of preventing cardiovascular disease through a public health lens. While traditional prevention efforts often focus on behaviors such as diet, exercise and smoking cessation, this study suggests that neighborhood conditions can also play a meaningful role in shaping cardiovascular risk.
Among the factors contributing most strongly to cardiovascular disease risk were neighborhood economic disadvantage, limited access to resources, employment patterns, food environments and crime rates. Researchers found that the combined effect of these factors provided a stronger predictor of cardiovascular disease risk than some existing measures of neighborhood disadvantage.
The study also identified differences across racial groups. Associations between neighborhood disadvantage and coronary artery calcification remained significant among Black participants later in adulthood, reinforcing concerns about health disparities across communities.
For public health professionals, the research highlights the need for prevention strategies that extend beyond clinical settings. Investments in neighborhood infrastructure, economic opportunity, access to healthy foods, safe spaces for physical activity and community development may all contribute to improving cardiovascular health outcomes at the population level.
“Cardiovascular disease remains the leading cause of death worldwide,” Zhang said. “By identifying the neighborhood conditions that contribute to risk earlier in life, we can better inform policies and interventions that promote healthier communities and prevent disease before it begins.” As communities and health systems increasingly recognize the role of social determinants of health, studies like this provide growing evidence that where people live is just as important as how they live when it comes to protecting long-term heart health.