title: Financial strain predicts recurrent events among women with coronary artery disease.
abstract: BACKGROUND
  Although a number of epidemiological studies have found an association between socioeconomic status (SES) indices such as income and education and coronary morbidity and mortality, few have looked at health consequences arising from actually experiencing financial shortcomings. The objective of the present study was to examine whether financial strain predicts recurrent coronary artery disease (CAD) events among women with established CAD.
  
  
  METHODS
  Two hundred two women (mean age 62+/-9 years) hospitalized for an acute coronary event were followed over a period of 3.5 years. Demographic, socioeconomic, lifestyle-related, psychosocial and biological characteristics were obtained by means of questionnaires and clinical examination. Data on recurrent cardiac events were collected from the Swedish discharge and death registers.
  
  
  RESULTS
  Women experiencing financial strain over the past year had an increased risk for recurrent events, i.e. the combination of all-cause mortality, new acute myocardial infarction and unstable angina pectoris during the follow-up with an unadjusted hazard ratio (HR) of 3.2 (95% CI 1.6-6.6), and a HR of 2.76 (95% CI 1.02-7.50) after controlling for education, household income, age, cohabiting status, inclusion diagnosis and rehabilitation therapy. Adjustment for potential mediators, i.e. psychosocial factors, lipids, diabetes mellitus, smoking, body-mass index, blood pressure, physical activity, alcohol consumption, participation in other cardiac rehabilitation programs did not alter the results significantly.
  
  
  CONCLUSIONS
  Financial strain was a predictor for recurrent events among women with CAD, independently of commonly used SES indicators such as education and household income. Future studies will have to explore the mechanism behind this association.
authors.affiliation: Preventive Medicine, Department of Public Health Sciences, Karolinska Institutet and Center of Public Health, Stockholm County Council, Stockholm, Sweden.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Georgiades
authors.forename: Imre
authors.initials: I
authors.lastname: Janszky
authors.forename: May
authors.initials: M
authors.lastname: Blom
authors.forename: Krisztina D
authors.initials: KD
authors.lastname: László
authors.forename: Staffan
authors.initials: S
authors.lastname: Ahnve
mesh_terms: D000208:Acute Disease; D000368:Aged; D003324:Coronary Artery Disease / Q000191:economics* / Q000401:mortality* / Q000523:psychology; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008875:Middle Aged; D009017:Morbidity; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000191:economics / Q000401:mortality*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology