Is There a Link Between Upward Wealth Mobility and Heart Health?

The findings of a new study suggest that people who ascend the financial ladder in middle age have better cardiovascular health. The findings were published this week in JAMA Cardiology.

Although the link between socioeconomic status and cardiovascular outcomes have been well described, the investigators pointed to the fact that little is known whether longitudinal changes in wealth are associated with cardiovascular health status. Therefore, this study aimed to discern any correlations between midlife wealth mobility and risk of cardiovascular events.

But, you may be asking, what’s the difference between income and wealth? “Income and wealth, while perhaps informally used interchangeably, actually provide different and complementary perspectives,” said Sara Machado, PhD, an economist at the Department of Health Policy at the London School of Economics via a press release about the study. “Income reflects money received on a regular basis, while wealth is more holistic, encompassing both assets and debts. Could paying off one’s debt without using an app that lets you borrow money with a large relative wealth increase be important in promoting cardiovascular health, even without changes in income?”

In this longitudinal, retrospective cohort study, researchers assessed a total of 5,579 US adults 50 years or older who participated in the Health and Retirement Study. The population had no history of cardiovascular disease and had medical observations in least two of three 5-year age intervals (50-54, 55-59, and 60-64 years) and follow-up after 65 years of age. Data were collected from January 1992, to December 2016, and analyzed from November 10, 2020, to April 26, 2021.

A Troubling Link Between Lower Economic Status and Worse Health

According to the results, following a mean follow-up of almost six years, 24% of the participants suffered a nonfatal cardiovascular event or death related to a cardiovascular event (the primary endpoint). The results showed that higher initial wealth (per quintile) was associated with lower cardiovascular risk.

When compared with those whose financial status remained unchanged, participants who experienced upward wealth mobility (of least 1 quintile) had less chance of suffering subsequent nonfatal cardiovascular events or cardiovascular death, while participants who went down the financial ladder had a higher risk of cardiovascular events.


“Decreases in wealth are associated with more stress, fewer healthy behaviors, and less leisure time, all of which are associated with poorer cardiovascular health,” said Andrew Sumarsono, MD from University of Texas Southwestern’s Division of Hospital Medicine. “It is possible that the inverse is true and may help to explain our study’s findings.”

“Low wealth is a risk factor that can dynamically change over a person’s life and can influence a person’s cardiovascular health status,” said Muthiah Vaduganathan, MD, MPH from the Brigham’s Division of Cardiovascular Medicine. “So, it’s a window of opportunity we have for an at-risk population. Buffering large changes in wealth should be an important focus for health policy moving ahead.”

“Wealth and health are so closely integrated that we can no longer consider them apart,” Dr. Vaduganathan added. “In future investigations, we need to make dedicated efforts to routinely measure wealth and consider it a key determinant of cardiovascular health.”