UMMS Affiliation

Department of Population and Quantitative Health Sciences

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Document Type



Cardiology | Cardiovascular Diseases | Environmental Public Health | Epidemiology | Health Services Research | Medicine and Health | Mental and Social Health | Sociology


Background: Medicine and public health are shifting away from a purely "personal responsibility" model of cardiovascular disease (CVD) prevention towards a societal view targeting social and environmental conditions and how these result in disease. Given the strong association between social conditions and CVD outcomes, we hypothesize that accelerated aging, measuring earlier health decline associated with chronological aging through a combination of biomarkers, may be a marker for the association between social conditions and CVD.

Methods: We used data from the Coronary Artery Risk Development in Young Adults study (CARDIA). Accelerated aging was defined as the difference between biological and chronological age. Biological age was derived as a combination of 7 biomarkers (total cholesterol, HDL, glucose, BMI, CRP, FEV1/h(2), MAP), representing the physiological effect of "wear and tear" usually associated with chronological aging. We studied accelerated aging measured in 2005-06 as a mediator of the association between social factors measured in 2000-01 and 1) any incident CVD event; 2) stroke; and 3) all-cause mortality occurring from 2007 through 18.

Results: Among 2978 middle-aged participants, mean (SD) accelerated aging was 3.6 (11.6) years, i.e., the CARDIA cohort appeared to be, on average, 3 years older than its chronological age. Accelerated aging partially mediated the association between social factors and CVD (N=219), stroke (N=36), and mortality (N=59). Accelerated aging mediated 41% of the total effects of racial discrimination on stroke after adjustment for covariates. Accelerated aging also mediated other relationships but to lesser degrees.

Conclusion: We provide new evidence that accelerated aging based on easily measurable biomarkers may be a viable marker to partially explain how social factors can lead to cardiovascular outcomes and death.


Accelerated aging, Cardiovascular disease, Psychosocial stress

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© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (

DOI of Published Version



Forrester SN, Zmora R, Schreiner PJ, Jacobs DR Jr, Roger VL, Thorpe RJ Jr, Kiefe CI. Accelerated aging: A marker for social factors resulting in cardiovascular events? SSM Popul Health. 2021 Jan 12;13:100733. doi: 10.1016/j.ssmph.2021.100733. PMID: 33532540; PMCID: PMC7823205. Link to article on publisher's site

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SSM - population health

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Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.