Article title: Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: implications for prevention
In high income countries, low socioeconomic status has been associated with an increased risk of incident acute coronary heart disease and stroke. Results of this study provide direction on who could benefit most through prevention guidance on cardiovascular disease. In conclusion, a lower social position as indexed by years of education accelerates the cumulative risk of incident cardiovascular disease in middle-aged European men and women initially free of cardiovascular disease. Socially disadvantaged subjects have most to gain from lifestyle and blood pressure modification. Their effective targeting to this end would reduce both the overall burden of CVD in the population, and its disproportionate impact on them.
Background The combined effect of social status and risk factors on the absolute risk of cardiovascular disease has been insufficiently investigated, but results provide guidance on who could benefit most through prevention.
Methods We followed 77,918 cardiovascular disease-free individuals aged 35–74 years at baseline, from 38 cohorts covering Nordic and Baltic countries, the UK and Central Europe, for a median of 12 years. Using Fine–Gray models in a competing-risks framework we estimated the effect of the interaction of education with smoking, blood pressure and body weight on the cumulative risk of incident acute coronary heart disease and stroke.
Results Compared with more educated smokers, the less educated had an added increase in absolute risk of cardiovascular disease of 3.1% (95% confidence interval + 0.1%, +6.2%) in men and of 1.5% (−1.9%, +5.0%) in women, consistent across smoking categories. Conversely, the interaction was negative for overweight: −2.6% (95% CI: −5.6%, +0.3%) and obese: −3.6% (−7.6%, +0.4%) men, suggesting that the more educated would benefit more from the same reduction in body weight. A weaker interaction was observed for body weight in women, and for blood pressure in both genders. Less educated men and women with a cluster of two or more risk factors had an added cardiovascular disease risk of 3.6% (+0.1%, +7.0%) and of 2.6% (−0.5%, +5.6%), respectively, compared with their more educated counterparts.
Conclusions Socially disadvantaged subjects have more to gain from lifestyle and blood pressure modification, hopefully reducing both their risk and also social inequality in disease.
Giovanni Veronesi, Hugh Tunstall-Pedoe, Marco M Ferrario, Frank Kee, Kari Kuulasmaa, Lloyd E Chambless, Philippe Amouyel, Dominique Arveiler, Martin Bobak, Jean Ferrieres, Simona Giampaoli, Torben Jørgensen, Annette Peters, Veikko Salomaa, Stefan Soderberg, Abdonas Tamosiunas, Giancarlo Cesana, and for the MORGAM Project
Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention
European Journal of Preventive Cardiology 2047487316679521, first published on November 11, 2016 doi:10.1177/2047487316679521