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Socioeconomic Status and Subclinical Coronary Disease in the Whitehall II Epidemiological Study

Steptoe, A; Hamer, M; O'Donnell, K; Venuraju, S; Marmot, MG; Lahiri, A; (2010) Socioeconomic Status and Subclinical Coronary Disease in the Whitehall II Epidemiological Study. PLOS ONE , 5 (1) , Article e8874. 10.1371/journal.pone.0008874. Green open access

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Abstract

Background: There are pronounced socioeconomic disparities in coronary heart disease, but the extent to which these primarily reflect gradients in underlying coronary artery disease severity or in the clinical manifestation of advanced disease is uncertain. We measured the relationship between socioeconomic status (SES) as indexed by grade of employment and coronary artery calcification (CAC) in the Whitehall II epidemiological cohort, and tested the contribution of lifestyle, biological and psychosocial factors in accounting for this association.Methods and Findings: CAC was assessed in 528 asymptomatic men and women aged 53-76 years, stratified into higher, intermediate and lower by grade of employment groups. Lifestyle (smoking, body mass index, alcohol consumption, physical activity), biological (blood pressure, lipids, fasting glucose, inflammatory markers) and psychosocial factors (work stress, financial strain, social support, depression, hostility, optimism) were also measured. Detectable CAC was present in 293 participants (55.5%). The presence of calcification was related to lifestyle and biological risk factors, but not to grade of employment. But among individuals with detectable calcification, the severity of CAC was inversely associated with grade of employment (p = 0.010), and this relationship remained after controlling for demographic, lifestyle, biological and psychosocial factors. Compared with the higher grade group, there was a mean increase in log Agatston scores of 0.783 (95% C. I. 0.265-1.302, p = 0.003) in the intermediate and 0.941 (C. I. 0.226-1.657, p = 0.010) in the lower grade of employment groups, after adjustment for demographic, lifestyle, biological and psychosocial factors.Conclusions: Low grade of employment did not predict the presence of calcification in this cohort, but was related to the severity of CAC. These findings suggest that lower SES may be particularly relevant at advanced stages of subclinical coronary artery disease, when calcification has developed.

Type: Article
Title: Socioeconomic Status and Subclinical Coronary Disease in the Whitehall II Epidemiological Study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0008874
Publisher version: http://dx.doi.org/10.1371/journal.pone.0008874
Language: English
Additional information: © 2010 Steptoe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This study was supported by the British Heart Foundation (RG/05/006). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Keywords: ARTERY RISK DEVELOPMENT, INTIMA-MEDIA THICKNESS, HEART-DISEASE, CARDIOVASCULAR-DISEASE, YOUNG-ADULTS, PSYCHOSOCIAL FACTORS, SOCIAL INEQUALITIES, CALCIFICATION, ATHEROSCLEROSIS, PROGRESSION
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > CRUK Cancer Trials Centre
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health
URI: https://discovery.ucl.ac.uk/id/eprint/111701
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