Socioeconomic status and subclinical coronary disease in the Whitehall II epidemiological study.

There are pronounced socioeconomic disparities in coronary heart disease, but the extent to which these primarily reflect gradients in underlying coronary artery disease severity or in the clinical manifestation of advanced disease is uncertain. We measured the relationship between socioeconomic sta...

Full description

Bibliographic Details
Main Authors: Andrew Steptoe, Mark Hamer, Katie O'Donnell, Shreenidhi Venuraju, Michael G Marmot, Avijit Lahiri
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2010-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC2810334?pdf=render
id doaj-4b1fd986edd5454fbf35a94630105ac6
record_format Article
spelling doaj-4b1fd986edd5454fbf35a94630105ac62020-11-24T21:48:06ZengPublic Library of Science (PLoS)PLoS ONE1932-62032010-01-0151e887410.1371/journal.pone.0008874Socioeconomic status and subclinical coronary disease in the Whitehall II epidemiological study.Andrew SteptoeMark HamerKatie O'DonnellShreenidhi VenurajuMichael G MarmotAvijit LahiriThere are pronounced socioeconomic disparities in coronary heart disease, but the extent to which these primarily reflect gradients in underlying coronary artery disease severity or in the clinical manifestation of advanced disease is uncertain. We measured the relationship between socioeconomic status (SES) as indexed by grade of employment and coronary artery calcification (CAC) in the Whitehall II epidemiological cohort, and tested the contribution of lifestyle, biological and psychosocial factors in accounting for this association.CAC was assessed in 528 asymptomatic men and women aged 53-76 years, stratified into higher, intermediate and lower by grade of employment groups. Lifestyle (smoking, body mass index, alcohol consumption, physical activity), biological (blood pressure, lipids, fasting glucose, inflammatory markers) and psychosocial factors (work stress, financial strain, social support, depression, hostility, optimism) were also measured. Detectable CAC was present in 293 participants (55.5%). The presence of calcification was related to lifestyle and biological risk factors, but not to grade of employment. But among individuals with detectable calcification, the severity of CAC was inversely associated with grade of employment (p = 0.010), and this relationship remained after controlling for demographic, lifestyle, biological and psychosocial factors. Compared with the higher grade group, there was a mean increase in log Agatston scores of 0.783 (95% C.I. 0.265-1.302, p = 0.003) in the intermediate and 0.941 (C.I. 0.226-1.657, p = 0.010) in the lower grade of employment groups, after adjustment for demographic, lifestyle, biological and psychosocial factors.Low grade of employment did not predict the presence of calcification in this cohort, but was related to the severity of CAC. These findings suggest that lower SES may be particularly relevant at advanced stages of subclinical coronary artery disease, when calcification has developed.http://europepmc.org/articles/PMC2810334?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Andrew Steptoe
Mark Hamer
Katie O'Donnell
Shreenidhi Venuraju
Michael G Marmot
Avijit Lahiri
spellingShingle Andrew Steptoe
Mark Hamer
Katie O'Donnell
Shreenidhi Venuraju
Michael G Marmot
Avijit Lahiri
Socioeconomic status and subclinical coronary disease in the Whitehall II epidemiological study.
PLoS ONE
author_facet Andrew Steptoe
Mark Hamer
Katie O'Donnell
Shreenidhi Venuraju
Michael G Marmot
Avijit Lahiri
author_sort Andrew Steptoe
title Socioeconomic status and subclinical coronary disease in the Whitehall II epidemiological study.
title_short Socioeconomic status and subclinical coronary disease in the Whitehall II epidemiological study.
title_full Socioeconomic status and subclinical coronary disease in the Whitehall II epidemiological study.
title_fullStr Socioeconomic status and subclinical coronary disease in the Whitehall II epidemiological study.
title_full_unstemmed Socioeconomic status and subclinical coronary disease in the Whitehall II epidemiological study.
title_sort socioeconomic status and subclinical coronary disease in the whitehall ii epidemiological study.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2010-01-01
description There are pronounced socioeconomic disparities in coronary heart disease, but the extent to which these primarily reflect gradients in underlying coronary artery disease severity or in the clinical manifestation of advanced disease is uncertain. We measured the relationship between socioeconomic status (SES) as indexed by grade of employment and coronary artery calcification (CAC) in the Whitehall II epidemiological cohort, and tested the contribution of lifestyle, biological and psychosocial factors in accounting for this association.CAC was assessed in 528 asymptomatic men and women aged 53-76 years, stratified into higher, intermediate and lower by grade of employment groups. Lifestyle (smoking, body mass index, alcohol consumption, physical activity), biological (blood pressure, lipids, fasting glucose, inflammatory markers) and psychosocial factors (work stress, financial strain, social support, depression, hostility, optimism) were also measured. Detectable CAC was present in 293 participants (55.5%). The presence of calcification was related to lifestyle and biological risk factors, but not to grade of employment. But among individuals with detectable calcification, the severity of CAC was inversely associated with grade of employment (p = 0.010), and this relationship remained after controlling for demographic, lifestyle, biological and psychosocial factors. Compared with the higher grade group, there was a mean increase in log Agatston scores of 0.783 (95% C.I. 0.265-1.302, p = 0.003) in the intermediate and 0.941 (C.I. 0.226-1.657, p = 0.010) in the lower grade of employment groups, after adjustment for demographic, lifestyle, biological and psychosocial factors.Low grade of employment did not predict the presence of calcification in this cohort, but was related to the severity of CAC. These findings suggest that lower SES may be particularly relevant at advanced stages of subclinical coronary artery disease, when calcification has developed.
url http://europepmc.org/articles/PMC2810334?pdf=render
work_keys_str_mv AT andrewsteptoe socioeconomicstatusandsubclinicalcoronarydiseaseinthewhitehalliiepidemiologicalstudy
AT markhamer socioeconomicstatusandsubclinicalcoronarydiseaseinthewhitehalliiepidemiologicalstudy
AT katieodonnell socioeconomicstatusandsubclinicalcoronarydiseaseinthewhitehalliiepidemiologicalstudy
AT shreenidhivenuraju socioeconomicstatusandsubclinicalcoronarydiseaseinthewhitehalliiepidemiologicalstudy
AT michaelgmarmot socioeconomicstatusandsubclinicalcoronarydiseaseinthewhitehalliiepidemiologicalstudy
AT avijitlahiri socioeconomicstatusandsubclinicalcoronarydiseaseinthewhitehalliiepidemiologicalstudy
_version_ 1725893407561220096