Cardiovascular disease (CVD) is disproportionately higher among low socioeconomic status communities. It is significantly associated with adverse psychosocial factors, rendering it a particularly salient health outcome in refugees who have been exposed to stressful and life-threatening events pre-resettlement and may experience barriers to assimilating to an unfamiliar host country post resettlement. Currently there is limited information about CVD risk among refugees as they settle in the United States. The objectives of the proposed project are therefore to thoroughly assess CVD risk in refugees resettled in Syracuse, New York, who are active patients of the ambulatory adult clinic at SUNY Medical Center. This study will provide a comprehensive assessment of CVD risk using a novel 3-prong approach that incorporates (1) traditional clinical risk prediction models using electronic health records data, (2) subclinical biological assessment of vascular aging in a subset of the sample, and (3) social and mental determinants of health contributing observed risk. Our findings from the CUSE project will provide a benchmark assessment of risk in diverse vulnerable populations as well as preliminary results for an NIH grant submission. This project will serve as the foundation for the development of a larger community-based longitudinal study that will be the first of its kind to study CVD risk and outcomes across the lifespan in the refugee community, in particular as current heart studies do not include refugee participants. The study will further provide a platform to develop evidence-based and culturally relevant interventions to reduce CVD risk in this underserved community.