TY - JOUR
T1 - Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts
T2 - Implications for prevention
AU - Veronesi, Giovanni
AU - Tunstall-Pedoe, Hugh
AU - Ferrario, Marco M.
AU - Kee, Frank
AU - Kuulasmaa, Kari
AU - Chambless, Lloyd E.
AU - Amouyel, Philippe
AU - Arveiler, Dominique
AU - Bobak, Martin
AU - Ferrieres, Jean
AU - Giampaoli, Simona
AU - Jørgensen, Torben
AU - Peters, Annette
AU - Salomaa, Veikko
AU - Soderberg, Stefan
AU - Tamosiunas, Abdonas
AU - Cesana, Giancarlo
AU - for the MORGAM Project
N1 - This work was supported by the MORGAM Project’s recent funding: European Community FP 7 projects ENGAGE (HEALTH-F4-2007-201413), CHANCES (HEALTH-F3-2010-242244) and BiomarCaRE (HEALTHF2-2011-278913). These grants supported central coordination, workshops and part of the activities of the MORGAM Data Centre, at the National Institute for Health and Welfare (THL) in Helsinki, Finland. MORGAM Participating Centres are funded by regional and national governments, research councils, charities and other local sources.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - 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.
AB - 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.
KW - Social inequalities
KW - Cardiovascular disease risk
KW - Differential vulnerability
KW - Additive interaction
KW - Competing risks
KW - Europe
U2 - 10.1177/2047487316679521
DO - 10.1177/2047487316679521
M3 - Article
C2 - 27837152
SN - 2047-4873
VL - 24
SP - 437
EP - 445
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 4
ER -