Impact of Social Determinants of Health on Cardiovascular Health and the Role of GP Practitioners as Indirect Modifiers

Abstract

Background: Cardiovascular diseases (CVD) are the leading cause of mortality among both genders older than the age of 45 years. The Social Determinants of Health (SDoH) determined in 2003 by the World Health Organization (WHO) are defined as the circumstances in which the individual is born, grows, works, lives, and age. SDoH are the underlying determinants, known as non-medical risk factors for CVD, shaping cardiovascular health (CVH). As the medical risk factors for CVD are well studied, the purpose of this literature review is to examine and emphasise the crucial interaction between SDoH and CVD with a focus on the role of general practitioners (GPs). Moreover, existing intervention strategies, current action goals, and possible further approaches are highlighted. Methods: A thematic, systematic, and comprehensive literature search using digital evidence-based medical databases, as well as E-books and E-journals was conducted from January to February 2024. Data were accessed digitally using the key words ‘social determinants of health’ and ‘cardiovascular diseases’. Subsequently, only relevant articles were selected for in-depth analysis, excluding articles exceeding a decade in age. Older documents published by international organisations or government institutions were included because of their historical and enduring relevance. Results: The impact of SDoH on CVH is omnipresent in all six domains identified by the WHO. These domains have been shown to be interconnected, complicating targeted interventions. Socially marginalized groups, particularly ethnic and racial minorities, experience a more pronounced influence of the SDoH. GPs play a crucial role as intermediaries between individuals and the health system. In addition, interventions initiated in early childhood demonstrate more significant and long-lasting effects. Successful multi-level intervention strategies are already implemented and recommended by research teams. However, they need to be distributed more efficiently to health care professionals. Furthermore, artificial intelligence and computer-generated algorithms are of great importance for future interventions. Nevertheless, the irreplaceable role of in-person consultations with general practitioners remains a cornerstone of effective healthcare interventions. Conclusion: In conclusion, SDoH have not received adequate attention. The most efficient reduction in CVD incidences requires a comprehensive, multi-level approach addressing SDoH in conjunction with lowering of medical risk factors. This strategy benefits the general public, impacting not only CVH, but also other diseases, reducing health inequity, and alleviating the financial burden on states. Moreover, recognizing the crucial role of GPs as indirect modifiers of health outcomes emphasizes the need to integrate their expertise in the holistic approach, contributing to the overall effectiveness of strategies aimed at mitigating the impact of SDoH on CVH.