. Author manuscript; available in PMC: 2020 Dec 14.

Published in final edited form as: Circulation. 2019 Mar 17;140(11):e596–e646. doi: 10.1161/CIR.0000000000000678

Table 2.

Example Considerations for Addressing Social Determinants of Health to Help Prevent ASCVD Events

Topic/Domain	Example Considerations
Cardiovascular risk	Adults should be routinely assessed for psychosocial stressors and provided with appropriate counseling.^S2.1-31
Cardiovascular risk	Health literacy should be assessed every 4 to 6 y to maximize recommendation effectiveness.^S2.1-36
Diet	In addition to the prescription of diet modifications, body size perception, as well as social and cultural influences, should be assessed.^{S2.1-37,S2.1-38}
Diet	Potential barriers to adhering to a heart-healthy diet should be assessed, including food access and economic factors; these factors may be particularly relevant to persons from vulnerable populations, such as individuals residing in either inner-city or rural environments, those at socioeconomic disadvantage, and those of advanced age^*.^S2.1-39
Exercise and physical activity	In addition to the prescription of exercise, neighborhood environment and access to facilities for physical activity should be assessed.^{S2.1-30,S2.1-40,S2.1-41}
Obesity and weight loss	Lifestyle counseling for weight loss should include assessment of and interventional recommendations for psychosocial stressors, sleep hygiene, and other individualized barriers.^{S2.1-42–S2.1-44}
Obesity and weight loss	Weight maintenance should be promoted in patients with overweight/obesity who are unable to achieve recommended weight loss.
Diabetes mellitus	In addition to the prescription of type 2 diabetes mellitus interventions, environmental and psychosocial factors, including depression, stress, self-efficacy, and social support, should be assessed to improve achievement of glycemic control and adherence to treatment.^{S2.1-45–S2.1-48}
High blood pressure	Short sleep duration (<6 h) and poor-quality sleep are associated with high blood pressure and should be considered.^S2.1-49 Because other lifestyle habits can impact blood pressure, access to a healthy, low-sodium diet and viable exercise options should also be considered.
Tobacco treatment	Social support is another potential determinant of tobacco use. Therefore, in adults who use tobacco, assistance and arrangement for individualized and group social support counseling are recommended.^{S2.1-50,S2.1-51}

Advanced age generally refers to age ≥75 years.

ASCVD indicates atherosclerotic cardiovascular disease.