Subclinical coronary atherosclerosis is more pronounced in men and women with lower socio-economic status: associations in a population-based study. Coronary atherosclerosis and social status.
BACKGROUND
Social inequalities of manifest coronary heart diseases are well documented in modern societies. Less evidence is available on subclinical atherosclerotic disease despite the opportunity to investigate processes underlying this association. Therefore, we examined the relationship between coronary artery calcification as a sign of subclinical coronary atherosclerosis, socio-economic status and established cardiovascular risk factors in a healthy population.


METHODS
Cross-sectional.


METHODS
In a population-based sample of 4487 men and women coronary artery calcification was assessed by electron beam computed tomography quantified by the Agatston score. Socio-economic status was assessed by two indicators, education and income. First, we investigated associations between the social measures and calcification. Second, we assessed the influence of cardiovascular risk factors on this association.


RESULTS
After adjustment for age, men with 10 and less years of formal education had a 70% increase in calcification score compared with men with high education. The respective increase for women was 80%. For income the association was weaker (among men 20% higher for the lowest compared with the highest quartile; and among women 50% higher, respectively). Consecutive adjustment for cardiovascular risk factors significantly attenuated the observed association of socio-economic status with calcification.


CONCLUSIONS
Social inequalities in coronary heart diseases seem to influence signs of subclinical coronary atherosclerosis as measured by coronary artery calcification. Importantly, cumulation of major cardiovascular risk factors in lower socio-economic groups accounted for a substantial part of this association.
Dragano
Nico
N
Department of Medical Sociology, University Clinic Düsseldorf, West-German Heart Center Essen, University Duisburg-Essen, Germany. dragono@uni-duesseldorf.de
Verde
Pablo Emilio
PE
Moebus
Susanne
S
Stang
Andreas
A
Schmermund
Axel
A
Roggenbuck
Ulla
U
Möhlenkamp
Stefan
S
Peter
Richard
R
Jöckel
Karl-Heinz
KH
Erbel
Raimund
R
Siegrist
Johannes
J
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007182:Income; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D012923:Social Class; D014057:Tomography, X-Ray Computed