title: Social status and cardiovascular disease: a Mediterranean case. Results from the Italian Progetto CUORE cohort study.
abstract: BACKGROUND
  Social factors could offer useful information for planning prevention strategy for cardiovascular diseases. This analysis aims to explore the relationship between education, marital status and major cardiovascular risk factors and to evaluate the role of social status indicators in predicting cardiovascular events and deaths in several Italian cohorts.
  
  
  METHODS
  The population is representative of Italy, where the incidence of the disease is low. Data from the Progetto CUORE, a prospective study of cohorts enrolled between 1983-1997, were used; 7520 men and 13127 women aged 35-69 years free of previous cardiovascular events and followed for an average of 11 years. Educational level and marital status were used as the main indicators of social status.
  
  
  RESULTS
  About 70% of the studied population had a low or medium level of education (less than high school) and more than 80% was married or cohabitating. There was an inverse relationship between educational level and major cardiovascular risk factors in both genders. Significantly higher major cardiovascular risk factors were detected in married or cohabitating women, with the exception of smoking. Cardiovascular risk score was lower in married or cohabitating men. No relationship between incidence of cardiac events and the two social status indicators was observed. Cardiovascular case-fatality was significantly higher in men who were not married and not cohabitating (HR 3.20, 95%CI: 2.21-4.64). The higher cardiovascular risk observed in those with a low level of education deserves careful attention even if during the follow-up it did not seem to determine an increase of cardiac events.
  
  
  CONCLUSIONS
  Preventive interventions on cardiovascular risk should be addressed mostly to people with less education. Cardiovascular risk score and case-fatality resulted higher in men living alone while cardiovascular factors were higher in women married or cohabitating. Such gender differences seem peculiar of our population and require further research on unexpected cultural and behavioural influences.
authors.affiliation: Research Centre on Public Health, Department of Clinical and Preventive Medicine, University of Milano-Bicocca, Monza, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Fornari
authors.forename: Chiara
authors.initials: C
authors.lastname: Donfrancesco
authors.forename: Michele A
authors.initials: MA
authors.lastname: Riva
authors.forename: Luigi
authors.initials: L
authors.lastname: Palmieri
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Diego
authors.initials: D
authors.lastname: Vanuzzo
authors.forename: Marco M
authors.initials: MM
authors.lastname: Ferrario
authors.forename: Lorenza
authors.initials: L
authors.lastname: Pilotto
authors.forename: Simona
authors.initials: S
authors.lastname: Giampaoli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cesana
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class