Worrying About Money and Food Ages the Heart Faster Than Traditional Risk Factors

A novel analysis investigating the contribution of social determinants of health (SDoH) to cardiac aging has found that financial strain and food insecurity are the strongest drivers of accelerated biological aging and increased mortality risk. The study in Mayo Clinic Proceedings, published by Elsevier, underscores the complexity and interplay of novel social risk factors that may contribute to cardiovascular events and emphasizes the need for targeted preventive interventions and patient-centered care.

The number of US residents aged 65 years and older is estimated to nearly double to 82 million people by the end of 2050, representing 23% of the total population. “Given the increasing life expectancy of the population and the enhanced burden of diseases in the elderly, the primary healthcare focus has shifted in the past decade to healthy aging and improved quality of life. This shift has also led to the search for new measures of biological aging,” explains lead investigator Amir Lerman, MD, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.

He adds, “Our current research was motivated by the observation that traditional risk factors do not explain and contribute equally to cardiovascular disease. There are social factors that we do not identify or inquire about from our patients that may potentially reverse biological aging.”

The cross-sectional study, investigating SDoH status with interaction to comorbidities and demographic risk factors in cardiac aging and mortality, included over 280,000 adult patients who sought care at Mayo Clinic between 2018 and 2023. Researchers assessed SDoH using a questionnaire that collects information across nine domains (stress, physical activity, social connection, housing instability, financial strain, food insecurity, transportation needs, nutrition, and education). They estimated cardiac age using an AI-enabled electrocardiogram (AI-ECG) algorithm and used structural equation modeling to map the connections between SDoH, conventional risk factors, and cardiac age gap.

Cardiac age gap

A higher cardiac age gap means the heart is biologically older than the individual, indicating increased risk for future cardiovascular disease. Despite previous efforts, accurate measurement of biological aging has been limited. This study highlights the use of innovative tools, such as the AI-ECG as a novel, noninvasive technique that provides valuable information regarding cardiac aging independently of chronological age. Detection of biological aging on routine ECG may point to the presence of non-traditional cardiovascular risk factors.

The authors point out that because the AI-ECG algorithm was validated internally at Mayo Clinic, and most survey respondents identify as non-Hispanic White, the study’s results may not apply precisely to other specific populations and racial or ethnic groups.

Key findings of the study are as follow:

• The interplay of SDoH was the most influential determinant of cardiac aging when compared with traditional clinical risk factors.

• Among all SDoH, financial strain and food insecurity were the most impactful in the overall population and sex-stratified analysis.

• SDoH such as financial strain, housing, and physical inactivity are robust predictors of increased mortality risk, matching or even surpassing certain conventional mortality risk factors.

Dr. Lerman concludes, “Our study highlights the critical role of SDoH in cardiac aging and mortality. Identifying the most important risk factors for cardiac aging allows for targeted preventive intervention in the community and empowers physicians to engage in patient-centered care, addressing the social context that contributes to heart disease.”

Notes for Editors

The article is “Interplay of Social Determinants of Health and Traditional Risk Factors in Predicting Cardiac Aging,”by Nazanin Rajai, MD, MPH; Betsy J. Medina-Inojosa, MD; Negin Mahmoudi Hamidabad, MD; Jose R. Medina-Inojosa, MD, MSc; Bradley R. Lewis, MS; Jaskanwal D. Sara, MCChB; Mark Nyman, MD; Zachi Attia, PhD; Lilach O. Lerman, MD, PhD; Paul A. Friedman, MD; Francisco Lopez-Jimenez, MD, MSc, MBA; and Amir Lerman, MD (https://doi.org/10.1016/j.mayocp.2025.01.024). The article appears in volume 100, issue 12 (December 2025) of Mayo Clinic Proceedings, published by Elsevier.

The article is openly available for 60 days at https://www.mayoclinicproceedings.org/article/S0025-6196(25)00106-5/fulltext.

Full text of the article is also available to credentialed journalists upon request. Contact Brittney Binns at +1 215 297 3278 or [email protected] to obtain copies or more information. Journalists wishing to speak to the authors should contact Amir Lerman, MD, at [email protected].

About Mayo Clinic Proceedings

Celebrating 100 years of continuous publication in 2025, Mayo Clinic Proceedings remains one of the premier online only peer-reviewed clinical journals in general and internal medicine. Content includes Nobel-prize-winning research, and the journal is among the most widely read and highly cited scientific publications for physicians. While the Proceedings is sponsored by Mayo Clinic, it welcomes submissions from authors worldwide, publishing articles that focus on clinical medicine and support the professional and educational needs of its readers. www.mayoclinicproceedings.org

About Mayo Clinic

Mayo Clinic is a nonprofit worldwide leader in medical care, research, and education for people from all walks of life. For more information visit www.mayoclinic.org/about and www.mayoclinic.org/news.

엘스비어 소개

엘스비어는 첨단 정보와 의사결정 지원 분야의 글로벌 선도 기업으로 100년 넘게 과학과 헬스케어의 발전을 지원하며 인류 진보에 기여해 왔습니다. 우리는 170개국 이상에서 학술 및 기업 연구 커뮤니티, 의사, 간호사, 미래의 의료 전문가와 교육자들을 지원합니다. 근거에 기반한 신뢰할 수 있는 과학·의학 콘텐츠와 최첨단 AI 기술을 결합해 중요한 통찰과 혁신적인 솔루션을 제공해, 의미있는 성과를 이루도록 돕고 있습니다. 또한 다양성과 지속 가능성을 제품과 기업 문화 전반에 내재화하며, 우리가 속한 커뮤니티와 협력합니다. 엘스비어 재단은 전 세계에서 연구와 보건 파트너십을 지원합니다.

엘스비어는 전문가 및 기업 고객에게 정보 기반의 분석과 의사결정 도구를 제공하는 글로벌 기업 RELX의 일원입니다. 자세한 내용은 www.elsevier.com에서 확인할 수 있으며, 소셜미디어 @elsevierconnect를 통해 최신 소식을 받아보실 수 있습니다.