Key result
Lower subjective social status is more strongly linked to cardiac fibrosis in females than males.
Why the study?
Subjective social status has been linked to cardiovascular morbidity with reported sex differences, motivating investigation of these differences using cardiac MRI markers of subclinical disease in healthy individuals.
Does subjective social status associate with imaging markers of cardiac inflammation and fibrosis differently in males and females free of cardiovascular disease?
Cross-Sectional (n=443)
Does subjective social status associate with imaging markers of cardiac inflammation and fibrosis differently in males and females free of cardiovascular disease?
Lower subjective social status is more strongly associated with subclinical cardiac fibrosis (elevated T1 mapping) in healthy females compared to males.
May link lower social status to fibrosis more in women; hypothesis-generating for sex-specific social determinants in primary prevention.
OBJECTIVE: Beyond objective socioeconomic status (SES) indicators, subjective social status (SSS), an individual's subjective perception of their social standing relative to others, has been independently linked to cardiovascular disease (CVD) morbidity and mortality. Some studies also report sex differences in the association between SSS and CVD. This study aimed to investigate these potential sex differences using advanced cardiac magnetic resonance imaging to detect subclinical CVD progression among healthy individuals. METHODS: A cross-sectional study was conducted with 443 participants (mean age = 56.40, SD = 10.88; 52.14% females) free of CVD. All participants underwent cardiac magnetic resonance imaging for quantitative assessment of T1 and T2 mapping, reflecting respectively diffuse fibrosis and edema, as part of inflammatory processes in the heart. SSS was measured using the MacArthur Subjective Social Status Scale. RESULTS: Female sex [b(SE) = 0.29 (0.10), p = .005], lower education [b(SE) = -0.23 (0.10), p = .026], and an interaction between sex and SSS [b(SE) = -0.15 (0.06), p = .019] were associated with higher T1 values, indicating a stronger association between lower SSS and cardiac fibrosis markers in females compared with males. No significant associations were found for T2 values. CONCLUSIONS: These findings extend the literature on the association of SSS with cardiovascular outcomes. Compared with males, females demonstrated a stronger association between lower SSS and an imaging marker of cardiac fibrosis among individuals free of CVD, further highlighting the relevance of sex-specific cardiovascular risk assessment.
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Sánchez‐Carro et al. (2025) conducted a cross-sectional in Healthy (free of cardiovascular disease) (n=443). Subjective social status (SSS) was evaluated on T1 and T2 mapping values (reflecting diffuse fibrosis and edema) (b = -0.15 (SE 0.06) for sex and SSS interaction on T1 values, p=0.019). Lower subjective social status was more strongly associated with higher T1 values, an imaging marker of cardiac fibrosis, in females compared with males (interaction b=-0.15, p=0.019).
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