title: Life Course Socioeconomic Position: Associations with Cardiac Structure and Function at Age 60-64 Years in the 1946 British Birth Cohort.
abstract: Although it is recognized that risks of cardiovascular diseases associated with heart failure develop over the life course, no studies have reported whether life course socioeconomic inequalities exist for heart failure risk. The Medical Research Council's National Survey of Health and Development was used to investigate associations between occupational socioeconomic position during childhood, early adulthood and middle age and measures of cardiac structure [left ventricular (LV) mass index and relative wall thickness (RWT)] and function [systolic: ejection fraction (EF) and midwall fractional shortening (mFS); diastolic: left atrial (LA) volume, E/A ratio and E/e' ratio)]. Different life course models were compared with a saturated model to ascertain the nature of the relationship between socioeconomic position across the life course and each cardiac marker. Findings showed that models where socioeconomic position accumulated over multiple time points in life provided the best fit for 3 of the 7 cardiac markers: childhood and early adulthood periods for the E/A ratio and E/e' ratio, and all three life periods for LV mass index. These associations were attenuated by adjustment for adiposity, but were little affected by adjustment for other established or novel cardio-metabolic risk factors. There was no evidence of a relationship between socioeconomic position at any time point and RWT, EF, mFS or LA volume index. In conclusion, socioeconomic position across multiple points of the lifecourse, particularly earlier in life, is an important determinant of some measures of LV structure and function. BMI may be an important mediator of these associations.
authors.affiliation: Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Murray
authors.affiliation: Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jones
authors.affiliation: Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.
authors.forename: Claudia
authors.initials: C
authors.lastname: Thomas
authors.affiliation: National Heart and Lung Institute, Imperial College Academic Health Sciences Centre, London, United Kingdom.|MRC Unit for Lifelong Health and Ageing, at University College London, London, United Kingdom.
authors.forename: Arjun K
authors.initials: AK
authors.lastname: Ghosh
authors.affiliation: British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: MRC Unit for Lifelong Health and Ageing, at University College London, London, United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hardy
authors.affiliation: MRC Unit for Lifelong Health and Ageing, at University College London, London, United Kingdom.
authors.forename: Diana
authors.initials: D
authors.lastname: Kuh
authors.affiliation: Institute of Cardiovascular Science, University College London, London, United Kingdom.
authors.forename: Alun D
authors.initials: AD
authors.lastname: Hughes
authors.affiliation: Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Whincup
mesh_terms: D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009790:Occupations; D012307:Risk Factors; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology