The European Society of Cardiology guidelines on cardiovascular disease (CVD) prevention,1 as well as their adaptation in Spain by the Spanish Interdisciplinary Vascular Prevention Committee,2 recommend the systematic assessment of cardiovascular risk in all adults without established CVD but who have 1 or more vascular risk factors. To support clinical decision-making, these guidelines propose the use of cardiovascular risk categories based on SCORE2 or SCORE2-OP (for individuals older than 70 years). In addition, the guidelines suggest taking into account several risk modifiers not included in the SCORE2/SCORE2-OP algorithms. These include psychosocial stress, socioeconomic status, evidence of subclinical atherosclerosis (eg, coronary calcium score), and other factors such as ethnicity, family history, genetic predisposition, environmental exposures, and relevant blood and urine biomarkers.

In 2010, the American Heart Association introduced the concept of ideal cardiovascular health, defined by 7 components collectively known as Life's Simple 7.3 In adults, these components include: being a nonsmoker (or having quit more than 12 months prior); following a heart-healthy diet; maintaining a body mass index <25kg/m2; engaging in moderate physical activity (≥150minutes/wk), vigorous activity (≥ 75minutes/wk), or a combination of both; achieving optimal blood pressure (BP) (systolic BP <120mmHg and diastolic BP <80mmHg); maintaining fasting blood glucose levels <100mg/dL; and having total cholesterol levels <200mg/dL. More recently, an eighth metric—healthy sleep duration—was added, leading to the updated framework known as Life's Essential 8 (LE8).4

This updated model of ideal cardiovascular health has been validated in numerous studies. A recent analysis based on the ENRICA cohort demonstrated that a substantial portion of the Spanish population exhibits low cardiovascular health according to the LE8 criteria.5 Notably, higher LE8 scores were associated with lower overall and cardiovascular-specific mortality. These findings are consistent with other population-based studies, where higher LE8 scores have been related to a reduced risk of coronary heart disease, stroke, and CVD.6

Despite existing evidence, certain common clinical scenarios, such as the assessment of cardiovascular risk in people with disabilities, remain inadequately explored in the general population. Although limited research is available on this topic, a recent study conducted in the United States using data from the National Health and Nutrition Examination Survey (NHANES)7 found that among individuals without established CVD, those with disabilities had significantly lower ideal cardiovascular health, as measured by Life's Essential 8 (LE8), compared with individuals without disabilities. Furthermore, in a comparison of 1300 adults with self-reported CVD and 13 656 adults free from CVD, disability was associated with a higher likelihood of having CVD. This association was particularly strong among younger individuals: the odds ratio (OR) for CVD in people with disabilities was 8.0 in the group aged 20 to 39 years, 5.8 in those aged 40 to 59 years, and 2.5 in those aged 60 to 79 years.

Revista Española de Cardiología recently published an outstanding study conducted in an adult Spanish population by Pastor-Barriuso et al.8 This research, notable for its high methodological quality and the relevance of its findings, merits strong recognition. The baseline prevalence of disability was 16.2% (95% confidence interval [95%CI], 15.9%-16.4%), and the study demonstrated a clear association between disability and increased cardiovascular mortality, particularly among individuals with moderate to severe disabilities. Compared with individuals without disabilities, the 5-year standardized hazard ratios (HRs) for cardiovascular mortality were 1.70 (95%CI, 1.40-1.93) for those with mild disabilities, 3.92 (95%CI, 3.23-4.76) for moderate disabilities, and 4.77 (95%CI, 3.42-6.66) for severe disabilities. These findings are consistent with those reported in previous studies,9,10 although earlier research often used heterogeneous definitions of disability. The study by Pastor-Barriuso et al.8 provides pioneering and robust population-based data in Spain, and, unlike prior studies, it offers detailed insights into the graded relationship between disability severity and cardiovascular mortality.

A major challenge lies in determining whether the observed association between disability and increased cardiovascular mortality can be explained by traditional cardiovascular risk factors, captured by tools such as SCORE2/SCORE2-OP or Life's Essential 8 (LE8), or whether additional, less easily quantifiable factors should also be considered. People with disabilities often experience a higher prevalence of stress, anxiety, depression, and sleep disturbances, as well as increased levels of social isolation, loneliness, discrimination, and lower socioeconomic status—all of which have been linked to elevated cardiovascular risk. Substantial evidence supports the role of chronic stress in the development and progression of CVD and hypertension.11 The underlying mechanisms are varied and include activation of the neuroendocrine and autonomic nervous systems—leading to elevated blood pressure and heart rate—along with endothelial dysfunction, and proinflammatory and prothrombotic responses.12 Human relationships are essential for maintaining health. Social connections are fundamental to health. Social isolation (an objective lack of social contact) and loneliness (a subjective sense of disconnection) reflect different dimensions of social relationships. Two recent meta-analyses have demonstrated that both social isolation and loneliness are associated with a significantly increased risk of CVD and higher overall mortality.13,14

A deeper understanding of the potential mechanisms underlying the increased cardiovascular mortality associated with disability could significantly enhance CVD prevention strategies in this high-risk population.15 Several studies have demonstrated that individuals with disabilities, compared to those without, are disproportionately affected by higher rates of overweight, obesity, and abdominal obesity. At the same time, they are more likely to experience extreme levels of sedentary behavior. When combined with other lifestyle risk factors, such as tobacco use and alcohol consumption, these conditions substantially elevate the risk of poor cardiovascular health in this population.16

These findings raise important questions about whether individuals with disabilities have equitable access to evidence-based preventive health services, including smoking cessation programs, nutritional counseling, physical activity promotion, and weight management support. There is a need to evaluate and implement targeted clinical interventions and policy strategies aimed at improving both the social and health environments of people with disabilities.15 These efforts should be complemented by public health initiatives tailored to the specific needs and age groups within this population.17