Study followed women for 20 years—one factor predicted heart health decline

A woman’s neighborhood may influence her heart health for decades, according to new research that found social and environmental conditions can be as important as personal habits and genetics when it comes to cardiovascular risk.

Dr. Miles Varn, chief medical officer for Sun Life U.S., told Newsweek that the findings show a woman’s address can carry as much weight as her cholesterol levels when assessing heart health in midlife.

“What is striking is that women living in socially vulnerable neighborhoods did not just start with worse cardiovascular health—they lost ground faster, especially before menopause even began,” Varn said. “That is a call to screen for social and neighborhood risk factors alongside traditional ones, and to intervene earlier than we typically do.

“If we want to close that gap, we cannot just treat the individual patient, we need to address the conditions in their community too.”

A Two-Decade Study

The research, led by the Harvard Pilgrim Health Care Institute, followed roughly 1,200 women in eastern Massachusetts for more than 20 years, from pregnancy through midlife.

Researchers measured heart health at five separate points using a score built from eight health and lifestyle factors, including blood pressure, cholesterol, sleep, diet and physical activity.

Living in Disadvantaged Areas Tied to Lower Scores

Women in the most socially vulnerable neighborhoods scored roughly six to 10 points lower on heart health measures than women in the least disadvantaged areas, a gap that showed up as early as three years into the study and lasted into midlife.

These women also saw their heart health decline more quickly in the years leading up to menopause, a stage of life already linked to rising cardiovascular risk.

Income, education and race also played a role. Women with lower income, less education, or who identified as non-Hispanic Black had lower heart health scores throughout the study period, researchers found.

Small Score Differences, Big Stakes

Because heart disease remains the leading cause of death among women, the study’s authors say the findings point to how years of exposure to specific and unchanging social and environmental conditions can shape cardiovascular risk over time.

Even small differences in heart health scores can matter. Earlier research has linked modest drops in these scores to a higher risk of both cardiovascular disease and death, suggesting the disparities identified in this study could carry lasting consequences.

Notably, the connection between neighborhood conditions and heart health held up even after researchers accounted for income and education separately. Women who spent years living in highly vulnerable neighborhoods showed consistently lower scores and steeper declines in heart health over time.

Beyond Personal Choices

“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,” senior author Izzuddin Aris said in a statement.

The study’s authors say the results point to potential solutions, including improving access to healthy food, safe places to exercise, and quality health care in disadvantaged communities.

The research drew on Project Viva, a long-running study that has tracked women since pregnancy in the early 2000s through midlife. That two-decade span of repeated health data allowed researchers to identify long-term patterns that shorter studies might miss.

Newsweek reached out to the researchers for more information via email.

Reference

Zhi, L., et al. (2026). Associations of Sociodemographic and Neighborhood Vulnerability With Cardiovascular Health in Midlife Women in the United States. Circulation: Population Health and Outcomes. https://doi.org/10.1161/CIRCOUTCOMES.126.013433.

Contact Newsweek editors on this story: Kara Dolman and Emma Lee-Sang