Adverse neighborhood conditions in early adulthood may raise the risk of early cardiovascular disease decades later.
Your ZIP code may reveal more about your future heart health than previously understood. In a new study published in Nature Communications, researchers found that people exposed to more adverse neighborhood conditions in early adulthood faced a greater risk of developing coronary artery calcification decades later, suggesting that the places people live can leave lasting biological fingerprints on the cardiovascular system.
The Northwestern Medicine team reached the finding using a newly developed index that combines multiple neighborhood characteristics, rather than examining them one at a time, to better capture the cumulative impact of local environments on cardiovascular health.
“This study helps move the field forward by shifting from a focus on individual lifestyle risk factors to a more comprehensive understanding of how neighborhood context shapes health,” said Lifang Hou, MD, PhD, professor of Preventive Medicine and of Pediatrics, who was senior author of the study.
Neighborhoods shape heart risk
Cardiovascular disease remains the leading cause of death in the U.S. and around the world, according to the Centers for Disease Control and Prevention.
A growing body of research has shown that where people live, including the broader environment around their homes, can affect both cardiovascular health and the likelihood of developing cardiovascular disease.
Earlier studies have examined how single social factors, such as income or education, are connected to heart health. Far fewer have looked at how several neighborhood conditions together may shape cardiovascular risk across many years, according to Hou.
“We identified a critical knowledge gap: the need for a more comprehensive way to measure neighborhood social determinants of health and understand how these exposures, starting in early adulthood, influence cardiovascular risk across the life course,” said Hou, who is also director of the Center for Global Oncology at the Robert J. Havey, MD Institute for Global Health.
A broader measure of exposure
To investigate that gap, Hou’s team analyzed data from the CARDIA (Coronary Artery Risk Development in Young Adults) study, a long-term cohort study that tracks how behavioral, environmental and race- and sex-associated factors influence cardiovascular disease development and aging. Using those data, the scientists built a new neighborhood social determinants of health index and connected it with coronary artery calcification (CAC), an important marker of early cardiovascular disease that had been measured repeatedly over time.
The scientists then applied advanced statistical and machine learning methods to examine how neighborhood social determinants related to cardiovascular risk after accounting for individual-level factors. They also assessed whether those relationships differed across patient populations.
Early conditions leave biological signs
The analysis showed that participants exposed to more adverse neighborhood social determinants of health in early adulthood faced a greater risk of developing CAC later in life. The connection was stronger among Black participants than among white participants.
Hou said the results indicate that neighborhood social determinants early in life can have long-lasting biological effects on cardiovascular health. The work could support more context-aware risk assessment in clinical care, guide population- and community-level prevention efforts, and improve understanding of differences in cardiovascular risk.
“By integrating multiple neighborhood social determinants into a single index, we can better capture how these factors accumulate over time and influence cardiovascular risk. Importantly, our findings show that neighborhood social determinants are not just abstract concepts — they are linked to measurable biological changes, such as coronary artery calcification,” Hou said.
Prevention targets may expand
Hou said her team plans to examine whether the same approach can be applied to other cardiovascular outcomes, including myocardial infarction and heart failure. The group also hopes to identify modifiable neighborhood social determinants of health that could serve as targets for intervention.
The scientists also plan to test the index in other patient cohorts and geographic settings. In addition, they want to better understand how shifts in neighborhood conditions over time may affect cardiovascular disease risk.
“This study highlights the unique value of long-term longitudinal research in uncovering how early-life neighborhood environments shape health across decades, providing important evidence to inform both clinical practice and population health strategies,” Hou said.
Reference: “Developing a novel index for neighborhood social determinants of cardiovascular diseases in the CARDIA study” by Tao Gao, Yinan Zheng, Brian T. Joyce, Lei Liu, Lili Liu, Catarina Kiefe, Sarah Forrester, Penny Gordon-Larsen, Chunyu Liu, Donald Lloyd-Jones, Kai Zhang and Lifang Hou, 31 March 2026, Nature Communications.
DOI: 10.1038/s41467-026-70741-4
The CARDIA study is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (75N92023D00002 and 75N92023D00005), Northwestern University (75N92023D00004), University of Minnesota (75N92023D00006) and Kaiser Foundation Research Institute (75N92023D00003). CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging (NIA) and an intra-agency agreement between NIA and NHLBI (AG0005). This work was also supported by American Heart Association grants 17SFRN33700278 and 14SFRN20790000 and NIA grants R01AG069120, R01AG081244 and U01AG088658.
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