Changes in midlife wealth influence cardiovascular health

A relative decline in wealth during midlife increases the likelihood of a cardiac event or heart disease after age 65 while an increase in wealth between ages 50 and 64 is associated with lower cardiovascular risk, according to a new study in JAMA Cardiology.

Although the association between socioeconomic status and cardiovascular outcomes is well established, little research has been done to determine whether longitudinal changes in wealth are associated with cardiovascular health. In the study, Andrew Sumarsono, M.D., an assistant professor of internal medicine at UT Southwestern, along with colleagues from Harvard-affiliated Brigham and Women's Hospital Heart & Vascular Center and the London School of Economics, investigated the cardiovascular toll that changes in monetary health can have in the U.S., where there is a 10- to 15-year difference in life expectancy between the population's richest 1 percent and the poorest 1 percent.

Examining a cohort of more than 5,500 adults without cardiovascular disease, they found that middle-aged participants who experienced upward wealth mobility – defined as relative increases in the total value of assets excluding primary residence – had lower cardiovascular risk after age 65 compared with peers of similar age. Conversely, participants who experienced downward wealth mobility in the latter parts of their careers had higher cardiovascular risk later in life. Cardiovascular events cited as outcomes include acute myocardial infarction, heart failure, cardiac arrhythmia, and stroke, or cardiac-related death.

"We already know that wealth relates to health, but we show that wealth trajectories also matter. This means that the cardiovascular risk associated with wealth is not permanent and can be influenced," says Sumarsono, a faculty member in the Division of Hospital Medicine.

The researchers estimate a 1 percent swing in cardiovascular risk for every $100,000 gained or lost by individuals. Notably, participants who started in the top 20 percent of wealth and experienced downward wealth mobility still had similar cardiovascular risk as those who remained fixed in the top quintile. However, those who started in the bottom fifth of wealth accumulation and experienced upward wealth mobility had lower cardiovascular risk than those fixed in the bottom quintile. The investigators suggest that this may indicate a potential legacy protection present among the wealthiest, but not the poorest. These findings linking wealth change and downstream cardiovascular events were similar across all racial or ethnic subgroups.

"We found that irrespective of one's baseline wealth, upward wealth mobility relative to peers in late-middle age was associated with lower risk of a new cardiac event or death after age 65. This suggests that upward wealth mobility may offset some of the risk associated with past economic hardship," Sumarsono says. "We also found the inverse was true – that people who experienced downward wealth mobility relative to one's peers faced a higher risk of a new cardiac event or death after 65, potentially offsetting some of the benefit associated with prior economic thriving.

"We live in a system where people can experience catastrophic losses in wealth from situations beyond their control and that opportunities to accrue wealth are not equally available across racial or socioeconomic groups," Sumarsono adds. "Policies that build resilience against large wealth losses and that address these opportunity gaps should be prioritized and may be considered a public health measure to improve overall health while also potentially narrowing racial, socioeconomic, and cardiovascular health disparities."