Long-term study shows how neighborhood conditions shape women's heart health

Women who live in disadvantaged neighborhoods face worse heart health and experience faster decline as they approach menopause, according to a long-term study led by the Harvard Pilgrim Health Care Institute.

Researchers followed 1,200 women in eastern Massachusetts for more than 20 years, from pregnancy into midlife. The study, published in Circulation: Population Health and Outcomes, measured heart health at five time points using a score based on eight health and lifestyle factors, including blood pressure, cholesterol, sleep, diet, and physical activity.

Key findings

Women living in the most socially vulnerable neighborhoods scored about 6 to 10 points lower on heart health across more than two decades of follow-up, compared with those in the least disadvantaged neighborhoods. These differences were evident as early as three years after enrollment and persisted into midlife. They also experienced faster declines before menopause, a key period for rising cardiovascular risk.

Socioeconomic factors also shaped outcomes. Women with lower income, less education, or who identified as Non-Hispanic Black had lower heart health scores throughout the study.

Because heart disease remains the leading cause of death for women, these findings highlight how long-term exposure to social and environmental conditions shapes cardiovascular risk over time.

Even modest differences in heart health scores may matter. Prior research suggests that small decreases in these scores are associated with higher risks of cardiovascular disease and mortality, underscoring the potential long-term impact of these disparities.

"Our study shows that heart health in midlife is shaped by more than personal choices. Income, education, and neighborhood conditions may all play a role," said senior author Izzuddin Aris, Harvard Medical School associate professor at the Harvard Pilgrim Health Care Institute.

Neighborhood conditions continued to affect heart health even after researchers considered income and education. Women who lived for years in highly vulnerable neighborhoods had persistently lower scores and worse cardiovascular health trajectories.

"The years before and around menopause may be an important time to support women's heart health," Aris added. "This is especially true for women living in under-resourced neighborhoods."

Implications for prevention

The findings highlight opportunities to improve access to healthy food, safe places to be active, and quality health care so women can protect their heart health over time.

About Project Viva

The study used data from Project Viva, a long-term research study that has followed women since pregnancy in the early 2000s through midlife. Researchers collected repeated health data over more than two decades, which allowed this study to capture long-term patterns in heart health.