Brunner, Eric John; (1994) Social class and risk factors for coronary heart disease. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This study examines explanations for the inverse social class gradient in coronary risk in the Whitehall II study utilising lipid and haemostatic variables. 8973 men and women employed in London offices of the Civil Service were surveyed in 1985-88. Participants aged 35-55 underwent measurements of height, weight, serum cholesterol and apolipoproteins AI and B (apoAI and apoB). Measurements of serum triglycerides (TG), plasma fibrinogen and factor VIIc were made in those aged 45-55. Questionnaires were completed on employment status and other socioeconomic indices, physical and mental health, health related behaviours, work characteristics, social supports, material, cognitive and affective factors. Higher employment grade was associated in both sexes with more favourable levels of TG, apoAI, apoB/apoAI ratio and fibrinogen. ApoB in women, and factor VIIc in men, showed declining trends with higher employment grade. Statistical adjustments for obesity, smoking, alcohol consumption, exercise, dietary pattern and recent symptoms attenuated the inverse socioeconomic gradients in coronary heart disease (CHD) risk factors. Inverse associations remained with apolipoprotein AI (both sexes), fibrinogen and TG (men only). Hypotheses were tested relating occupational, social and personal psychosocial factors and material circumstances to apoAI, the apoB/apoAI ratio and fibrinogen. Higher variety and skill use at work were associated with more favourable levels of apolipoproteins and fibrinogen in both sexes. Other work characteristics showed less consistent relationships with risk factors. In both sexes financial difficulties are associated with less favourable levels of apolipoproteins. Amongst men, hostility and fatalism are related to less favourable levels of apolipoproteins or fibrinogen. It is concluded that the expected inverse socioeconomic gradient in CHD in this population may in part be accounted for by apoAI, apoB, TG and fibrinogen, but not by total cholesterol or factor VIIc levels. High levels of psychosocial demands and adverse material circumstances, which are associated with low employment grade, are linked to less favourable levels of apolipoproteins and fibrinogen. These effects appear largely to be mediated by associations with obesity and health related behaviours.

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