ASCVD risk begins early in life, with heightened susceptibility tied to low socioeconomic status.181 Examples of upstream SDoH that affect adherence and ASCVD health outcomes include comorbid mental illness, low health literacy, exposure to adversity (eg, home/community violence, trauma exposures, safety concerns), financial strain, inadequate housing conditions, food insecurity (eg, access to affordable and nutritious food), and inadequate social support.182 Systems of care should evaluate SDoH that affect care delivery for the primary prevention of ASCVD (eg, transportation barriers, the availability of health services). Important considerations related to socioeconomic disadvantage are not captured by existing ASCVD risk equations.183 Addressing unmet social needs improves management of BP and lipids,184 highlighting the importance of dietary counseling and encouraging physical activity.185 More time may be required to address ASCVD prevention when working with adults of low health literacy or disadvantaged educational backgrounds. Differential cardiovascular outcomes persist by important sociodemographic characteristics, including but not limited to age, gender, and race/ethnicity.186 189 Failure to address the impact of SDoH impedes efficacy of proven prevention recommendations. Standardized use of EHRs that include social and behavioral domains could improve care for patients with HBP. Table A outlines social and behavioral domains that may be integrated into EHRs to address SDoH.190 Clinical Recommendations 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease14 Recommendations for Addressing Social Determinants of Health (SDoH) (Section 2.1, 2019 Prevention Guideline) Social determinants of health should inform optimal implementation of treatment recommendations for the prevention of ASCVD.178 181,185,189,191 (Class 1, Level of Evidence: B-NR) ACC indicates American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; CDU, care delivery unit; EHR, electronic health record; HBP, high blood pressure; and SDoH, social determinants of health. 39 Appendix A. Continued Table A. 