SDOH Influences on Chronic Stress: The Physiological Cost That Increases Risk of Heart Disease in Early Midlife African American Women

In this chapter, we discuss the burgeoning increase of heart disease in young Black women and the connection between socially derived stressors and cardiovascular risk. The discussion of social determinants of health with emphasis on racism and its exertive effects on the social context of Black women including wage inequities, wealth, neighborhood, and health behaviors are discussed and their possible connections as mediators of cardiovascular disease risk and accelerated aging. Our focus in this chapter is on stress physiology and what happens when this system remains under duress. Overtaxing of physiological system resulting from the deleterious effects of chronic stress is postulated to produce adverse effects on the physiological system that has been associated with cardiovascular disease risk promoting behaviors as well as preclinical CVD. We connect these factors to demonstrate how this may increase the vulnerability and susceptibility of CVD and accelerated biological aging in Black women. Understanding the importance of targeting younger Black women earlier in the lifecourse into clinical research is imperative to achieving health equity in this group of women. We discuss a clinical research study that is underway to address some of these challenges, barriers, and solutions that may hinder the successful recruitment and enrollment of this subpopulation of women.