Early-Adult Neighborhood Conditions Linked to Midlife Coronary Calcification

Neighborhood conditions experienced in early adulthood were associated with a higher likelihood of coronary artery calcification by midlife in a new analysis of the long-running CARDIA study. The findings, published in Nature Communications, point to neighborhood-level social conditions as a factor that may be relevant to cardiovascular risk across the life course.

The researchers developed an index combining several characteristics of the areas where participants lived, including socioeconomic conditions, food access, opportunities for physical activity and local crime rates. They then compared scores on the index with repeated measurements of coronary artery calcification, or CAC.

CAC refers to calcium deposits in the coronary arteries and is used as an indicator of early cardiovascular disease. Participants who experienced more unfavorable neighborhood conditions as young adults had a higher risk of developing CAC later in life. The reported association was stronger among Black participants than among white participants.

The analysis used data from CARDIA, a longitudinal cohort study examining how behavioral, environmental, race- and sex-associated factors relate to cardiovascular disease development and aging. Northwestern Medicine researchers applied statistical methods and machine learning while accounting for individual-level factors. The study’s lead author was Tao Gao, MD, and Lifang Hou, MD, PhD, was the senior author.

The work addresses a gap identified by the researchers: although earlier studies have linked individual social factors such as income and education with cardiovascular health, fewer have examined multiple neighborhood conditions together over an extended period. The new index was intended to capture how those conditions may accumulate rather than treating each factor in isolation.

The findings suggest that neighborhood context may be connected with measurable cardiovascular changes, but they do not show that living in a particular type of neighborhood directly causes coronary calcification. CAC is an early marker of cardiovascular disease, not a measurement of heart attacks, heart failure or lifespan. The study also does not establish that changing a neighborhood or an individual’s circumstances would prevent CAC.

The researchers said they plan to examine whether the same neighborhood factors are associated with additional cardiovascular outcomes, including myocardial infarction and heart failure. They also plan to test the index in other populations and geographic areas, identify potentially modifiable neighborhood conditions, and study whether changes in neighborhood conditions over time are associated with cardiovascular risk.