Cardiorespiratory fitness mediates the association between neighborhood deprivation and arterial stiffness in women.

Cardiovascular diseases remain the leading cause of death among women in the United States, and arterial stiffness is a strong predictor of cardiovascular events and mortality. Growing evidence suggests that neighborhood socioeconomic context contributes to cardiovascular risk, yet the physiological pathways linking neighborhood disadvantage to vascular health remain unclear. This study examined whether cardiorespiratory fitness (CRF) mediates the association between neighborhood deprivation (ND) and arterial stiffness in postmenopausal women. Ninety-one Black and White postmenopausal women [47 and 44, respectively, age: 64(8) yr] completed maximal treadmill testing to determine peak oxygen uptake ([Formula: see text]), and arterial stiffness was assessed via carotid-femoral pulse wave velocity (cf-PWV). ND was quantified using the area deprivation index averaged across residential addresses over the previous 25 yr. ND was associated with both lower [Formula: see text] (<i>r</i> = -0.45, <i>P</i> < 0.001) and higher cf-PWV (<i>r</i> = 0.28, <i>P</i> = 0.008). In hierarchical regression models adjusting for age, systolic blood pressure, and race, [Formula: see text] emerged as the strongest predictor of cf-PWV (B = -0.10, <i>P</i> = 0.003). Mediation analysis using bootstrapping revealed a significant indirect effect of ND on cf-PWV through [Formula: see text], whereas the direct effect of ND was not significant, consistent with indirect-only mediation. These findings suggest that lower CRF may partially explain the relationship between ND and vascular aging among postmenopausal women. Thus, efforts should be focused on improving access to physical activity opportunities for women facing high levels of social disadvantage.<b>NEW & NOTEWORTHY</b> Neighborhood disadvantage is associated with increased cardiovascular risk, yet the physiological pathways linking social environments to vascular health remain unclear. In postmenopausal women, we found that cardiorespiratory fitness mediated the relationship between neighborhood deprivation and arterial stiffness. Higher neighborhood deprivation was associated with lower fitness, which in turn was associated with greater arterial stiffness. These findings highlight cardiorespiratory fitness as a potential physiological and modifiable pathway linking adverse social environments to vascular aging.