Abstract MP01: Disentangling The Relationship Between Genetic Predisposition And Social Environment In The Development Of Myocardial Infarction

Abstract

Background: The interrelatedness between social determinants of health impedes researchers to identify important social factors for cardiovascular health. A new approach is needed to quantify the aggregate effect of social factors and develop person-centered interventions. In addition, it remains largely unknown whether social environment could offset the increased risk of cardiovascular disease among genetically predisposed persons. Objective: This study aimed to create a polysocial score to comprehensively quantify the effect of a variety of social factors of myocardial infarction (MI) and examine the synergistic effect of genetic and social factors for predicting MI. Methods: Data are from the 2006 or 2008 wave of the Health and Retirement Study. Social determinants of health encompassed five social domains: economic stability, neighborhood and physical environment, education, community and social context, and healthcare system. We used the forward stepwise logistic regression to derive a polysocial score model for 10-year incidence of MI. We calculated the incidence rate by each polygenic score tertile and polysocial score tertile. We used the interaction approach to examine the synergistic effect of polygenic score (continuously) and polysocial score (continuously) on MI. Results: 4,372 participants (55% female) initially free of MI were included. A polysocial score for MI was created using five social determinants of health. Participants with intermediate (OR=0.72; 95% CI, 0.54, 0.95) and high (OR=0.46; 95% CI, 0.33, 0.64) polysocial scores had lower odds of MI than those with low polysocial scores. In each tertile of polygenic score, higher polysocial score was associated with a lower incidence of MI. Compared with persons with a low polygenic and a high polysocial score, those with a high polygenic and low polysocial score had a 5-fold higher odds of MI (95% CI: 2.51, 11.50). A desirable social environment, indicated by a high polysocial score, could offset the increased risk of MI among persons with a high genetic risk. The incidence rate of MI was 7 per 1,000 person-years (PYs) for persons with a low genetic predisposition but an undesirable polysocial score and was 7 per 1,000 person-years (PYs) for those with a high genetic predisposition but a desirable polysocial score. Results persisted after adjustment of sex, age, and race/ethnicity (white and black). Conclusion: The polysocial approach may offer possible solutions to monitor social environments and suggestions for older people to improve their social status for cardiovascular health regardless of level of genetic predisposition. Establishment of a desirable social environment could offset the increased risk of cardiovascular disease associated with genetics.