title: Social factors and coping status in asymptomatic middle-aged Danes: association to coronary artery calcification.
abstract: OBJECTIVE
  Understanding the determinants of social and coping inequalities in subclinical cardiovascular disease is an important prerequisite in developing and implementing preventive strategies. The aim of this study was to investigate the association between social factors and coping status, respectively, and subclinical coronary artery disease (CAD) in middle-aged Danes.
  
  
  METHODS
  This is a DanRisk screening substudy, thus including healthy Danish males and females aged 50 or 60 years. Social measures included grade of education, employment and co-habiting status. The coping status was estimated by the general self-efficacy (GES) scale. Coronary artery calcification (CAC) was assessed by computed tomography using the Agatston score (AS). Conventional clinical risk factors included sex, family history of CAD, BMI > 25, smoking, hypercholesterolaemia and hypertension.
  
  
  RESULTS
  In 568 individuals the prevalence of subjects with CAC was 267 (45%). Independent predictors of CAC in males were age (OR = 1.10, 95% CI = 1.04-1.16, p < 0.001), smoking (OR = 1.75, 95% CI = 1.03-2.99, p = 0.038), and low co-habiting status (OR = 3.66, 95% CI = 1.19-11.25, p = 0.023). Independent predictors in females were age (OR = 1.67, 95% CI = 1.02-1.12, p = 0.006), and smoking (OR = 1.71, 95% CI = 1.06-2.78, p = 0.029). Higher AS was associated to lower employment level in females (p = 0.001) but not in males (p = 0.833).
  
  
  CONCLUSIONS
  Social factors are associated to the prevalence and severity of CAC in asymptomatic middle-aged individuals with gender differences. The relative value of gender specific social versus conventional clinical risk factors in the risk assessment of subclinical CAC in middle-aged individuals needs further investigation in future prospective studies.
authors.affiliation: 1Department of Cardiology, Lillebaelt Hospital-Vejle, Denmark.
authors.forename: Rikke Elmose
authors.initials: RE
authors.lastname: Mols
authors.forename: Niels Peter
authors.initials: NP
authors.lastname: Sand
authors.forename: Jesper Møller
authors.initials: JM
authors.lastname: Jensen
authors.forename: Kristian
authors.initials: K
authors.lastname: Thomsen
authors.forename: Axel C P
authors.initials: AC
authors.lastname: Diederichsen
authors.forename: Bjarne Linde
authors.initials: BL
authors.lastname: Nørgaard
mesh_terms: D000223:Adaptation, Psychological; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000523:psychology*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D061205:Vascular Calcification / Q000453:epidemiology / Q000523:psychology*
keywords: Computed tomography; coping status; coronary artery calcification; coronary artery disease; social factors