While social determinants of health (SDOH) are known to influence outcomes in acquired cardiovascular diseases, their impact on conditions with a strong genetic basis, such as hypertrophic cardiomyopathy (HCM), has been less clear.² A new study using data from the Sarcomeric Human Cardiomyopathy Registry (SHaRe) suggests that area-based social factors are independently associated with adverse clinical outcomes in patients with HCM.¹
Methodology
This multicentre, prospective cohort study analysed data from 4,431 adult patients with HCM across five US sites participating in the SHaRe registry. Researchers geocoded patients' residential addresses at the zip code level to determine two key area-based SDOH metrics: median household income and the Social Deprivation Index (SDI), a composite measure where higher scores indicate greater deprivation.
The primary outcomes were composite endpoints for heart failure (HF), defined as NYHA class III/IV symptoms, cardiac transplant, or LVAD implantation; ventricular arrhythmias (VA), including sudden cardiac death, resuscitated cardiac arrest, or appropriate ICD therapy; and an overall composite outcome that included HF, VA, atrial fibrillation, stroke, and all-cause death. The median follow-up period was 2.15 years.
Results
After adjusting for age, sex, body mass index, and hypertension, the study found significant associations between SDOH and clinical outcomes.
Patients living in areas with the lowest median household income had a significantly higher risk for the HF composite (adjusted HR: 2.07; 95% CI: 1.77–2.42; p<0.001) and the overall composite outcome (adjusted HR: 1.52; 95% CI: 1.36–1.69; p<0.001) compared to those in the highest income areas.
Similarly, patients in the most deprived areas (highest SDI) had an increased risk for the HF composite (adjusted HR: 1.48; 95% CI: 1.29–1.70; p<0.001), the VA composite (adjusted HR: 1.55; 95% CI: 1.15–2.09; p=0.004), and the overall composite outcome (adjusted HR: 1.36; 95% CI: 1.22–1.50; p<0.001) compared to those in the least deprived areas.
In Practice/Interpretation
The study demonstrates that where a person lives is associated with their clinical trajectory in HCM. The authors concluded, “These findings suggest that despite the genetically determined nature of HCM, place of residence is associated with patient outcomes.”¹ The results indicate that area-based SDOH could be a useful factor for risk assessment in this patient population.
Next Steps
The authors suggest that while these readily accessible area-based factors may help identify patients at higher risk, further research is necessary. Future studies are needed to develop strategies to mitigate risk and improve access to care for patients with HCM who are affected by adverse social determinants of health.
This study was funded by BioMarin, Bristol Myers Squibb, Cytokinetics, Lexicon Pharmaceuticals, and Tenaya Therapeutics.
References
1. Hafeez N, Claggett BL, Owens AT, et al. Social Determinants of Health and Clinical Outcomes in Hypertrophic Cardiomyopathy. JAMA Cardiol. 2026. https://doi.org/10.1001/jamacardio.2025.4869.
2. Powell-Wiley TM, Baumer Y, Baah FO, et al. Social determinants of cardiovascular disease. Circ Res. 2022;130(5):782–799. https://doi.org/10.1161/CIRCRESAHA.121.319811.
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