Social Risk Factors Drive Cardiovascular Risk in Older Adults with Prediabetes

A decade-long analysis of U.S. adults with prediabetes has revealed that certain social risk factors—particularly low educational attainment, financial hardship, and lack of health insurance—are significantly associated with poorer cardiovascular outcomes over time.

Published in Aging, the study drew from the nationally representative Health and Retirement Study (HRS), focusing on 5,086 adults aged 50 and older with biomarker-confirmed prediabetes. Researchers examined how five social risk domains—economic stability, neighborhood environment, education, healthcare access, and social context—predicted key cardiometabolic measures: hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and cholesterol ratio (total cholesterol to HDL).

The findings were unequivocal: among all the social risk factors analyzed, limited education stood out as the most consistent and robust predictor of elevated cardiovascular disease (CVD) risk. Even after adjusting for age, sex, race, comorbidities, and other social risks, low education was associated with increases in HbA1c (β = 0.03), SBP (β = 4.34 mmHg), and cholesterol ratio (β = 0.08), all with statistically significant confidence intervals.

Economic instability was another key determinant. Participants who reported difficulty paying bills had significantly higher cholesterol ratios (β = 0.08), and those in the lowest income or asset quartile also showed increased cholesterol risk (β = 0.12). In addition, individuals who reported taking less medication due to cost had slightly but significantly higher HbA1c levels (β = 0.03).

Lack of health insurance—though uncommon in this older cohort—was one of the strongest predictors of elevated cholesterol. Uninsured participants had a 0.22-point higher cholesterol ratio on average compared to their insured counterparts, a finding the authors linked to reduced access to preventive care and lipid-lowering treatment.

Neighborhood and social context factors such as food insecurity, social cohesion, and perceived discrimination showed less consistent associations with cardiometabolic outcomes in fully adjusted models. However, the cumulative burden of multiple social risks was acknowledged as a significant public health concern.