title: Socioeconomic status, pathogen burden and cardiovascular disease risk.
abstract: OBJECTIVE
  Socioeconomic status (SES) is inversely associated with coronary heart disease (CHD) risk. Cumulative pathogen burden may also predict future CHD. The hypothesis was tested that lower SES is associated with a greater pathogen burden, and that pathogen burden accounts in part for SES differences in cardiovascular risk factors.
  
  
  METHODS
  This was a cross-sectional observational study involving the clinical examination of 451 men and women aged 51-72 without CHD, recruited from the Whitehall II epidemiological cohort. SES was defined by grade of employment, and pathogen burden by summing positive serostatus for Chlamydia pneumoniae, cytomegalovirus and herpes simplex virus 1. Cardiovascular risk factors were also assessed.
  
  
  RESULTS
  Pathogen burden averaged 1.94 (SD) 0.93 in the lower grade group, compared with 1.64 (0.97) and 1.64 (0.93) in the intermediate and higher grade groups (p = 0.011). Pathogen burden was associated with a higher body mass index, waist/hip ratio, blood pressure and incidence of diabetes. There were SES differences in waist/hip ratio, high-density lipoprotein-cholesterol, fasting glucose, glycated haemoglobin, lung function, smoking and diabetes. The SES gradient in these cardiovascular risk factors was unchanged when pathogen burden was taken into account statistically.
  
  
  CONCLUSIONS
  Although serological signs of infection with common pathogens are more frequent in lower SES groups, their distribution across the social gradient does not match the linear increases in CHD risk present across higher, intermediate and lower SES groups. Additionally, pathogen burden does not appear to mediate SES differences in cardiovascular risk profiles.
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. a.steptoe@ucl.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Steptoe
authors.forename: A
authors.initials: A
authors.lastname: Shamaei-Tousi
authors.forename: A
authors.initials: A
authors.lastname: Gylfe
authors.forename: B
authors.initials: B
authors.lastname: Henderson
authors.forename: S
authors.initials: S
authors.lastname: Bergström
authors.forename: M
authors.initials: M
authors.lastname: Marmot
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000382:microbiology; D002690:Chlamydia Infections / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology / Q000382:microbiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D006561:Herpes Simplex / Q000453:epidemiology; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors