Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention

Giovanni Veronesi (Lead / Corresponding author), 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, for the MORGAM Project

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)437-445
Number of pages10
JournalEuropean Journal of Preventive Cardiology
Volume24
Issue number4
Early online date11 Nov 2016
DOIs
Publication statusPublished - 1 Mar 2017

Fingerprint

Educational Status
Coronary Disease
Stroke
Incidence
Cardiovascular Diseases
Body Weight
Blood Pressure
Smoking
Scandinavian and Nordic Countries
Vulnerable Populations
Life Style
Confidence Intervals
Education

Keywords

  • Social inequalities
  • Cardiovascular disease risk
  • Differential vulnerability
  • Additive interaction
  • Competing risks
  • Europe

Cite this

Veronesi, Giovanni ; Tunstall-Pedoe, Hugh ; Ferrario, Marco M. ; Kee, Frank ; Kuulasmaa, Kari ; Chambless, Lloyd E. ; Amouyel, Philippe ; Arveiler, Dominique ; Bobak, Martin ; Ferrieres, Jean ; Giampaoli, Simona ; Jørgensen, Torben ; Peters, Annette ; Salomaa, Veikko ; Soderberg, Stefan ; Tamosiunas, Abdonas ; Cesana, Giancarlo ; 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. In: European Journal of Preventive Cardiology. 2017 ; Vol. 24, No. 4. pp. 437-445.
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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",
abstract = "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.",
keywords = "Social inequalities , Cardiovascular disease risk , Differential vulnerability , Additive interaction , Competing risks , Europe",
author = "Giovanni Veronesi and Hugh Tunstall-Pedoe and Ferrario, {Marco M.} and Frank Kee and Kari Kuulasmaa and Chambless, {Lloyd E.} and Philippe Amouyel and Dominique Arveiler and Martin Bobak and Jean Ferrieres and Simona Giampaoli and Torben J{\o}rgensen and Annette Peters and Veikko Salomaa and Stefan Soderberg and Abdonas Tamosiunas and Giancarlo Cesana and {for the MORGAM Project}",
note = "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.",
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Veronesi, G, Tunstall-Pedoe, H, Ferrario, MM, Kee, F, Kuulasmaa, K, Chambless, LE, Amouyel, P, Arveiler, D, Bobak, M, Ferrieres, J, Giampaoli, S, Jørgensen, T, Peters, A, Salomaa, V, Soderberg, S, Tamosiunas, A, Cesana, G & for the MORGAM Project 2017, '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, vol. 24, no. 4, pp. 437-445. https://doi.org/10.1177/2047487316679521

Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts : Implications for prevention. / Veronesi, Giovanni (Lead / Corresponding author); Tunstall-Pedoe, Hugh; Ferrario, Marco M.; Kee, Frank; Kuulasmaa, Kari; Chambless, Lloyd E.; Amouyel, Philippe; Arveiler, Dominique; Bobak, Martin; Ferrieres, Jean; Giampaoli, Simona; Jørgensen, Torben; Peters, Annette; Salomaa, Veikko; Soderberg, Stefan; Tamosiunas, Abdonas; Cesana, Giancarlo; for the MORGAM Project.

In: European Journal of Preventive Cardiology, Vol. 24, No. 4, 01.03.2017, p. 437-445.

Research output: Contribution to journalArticle

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

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VL - 24

SP - 437

EP - 445

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

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ER -