What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular disease-free (n=3042). Intervention: Socio-economic status vs. Lowest socio-economic status tertile. Primary outcome: Clinical and biochemical factors related to coronary heart disease.

February 1, 2005Open Access

Socio-Economic Status in Relation to Risk Factors Associated with Cardiovascular Disease, in Healthy Individuals from the ATTICA Study

Key Result

Higher socio-economic status was inversely associated with cardiovascular risk factors, including lipids, glucose, and inflammatory markers, compared to the lowest SES tertile.

Study Design

Type

Cross-Sectional (n=3,042)

Structured PICO

Does higher socio-economic status associate with improved cardiovascular risk factor profiles in healthy individuals?

Population

3,042 cardiovascular disease-free men and women aged 20-89 years from the Attica region, Greece.

Exposure

Highest tertile of socio-economic status (SES) index (years of school by annual income)

Comparator

Lowest tertile of socio-economic status (SES) index

Outcome

Levels of established and emerging cardiovascular risk factors (lipids, glucose, BMI, waist-to-hip ratio, CRP, fibrinogen, homocysteine, TNF-alpha, IL-6, WBC)surrogate

Higher socio-economic status is inversely associated with established and emerging cardiovascular risk factors, including inflammatory markers, in healthy individuals.

Limitations

The causal pathway requires more detailed explanation before social status can have explanatory power.

Abstract

BACKGROUND: Social status has been related with the prevalence and incidence of cardiovascular disease. The aim of this study is to investigate the relationships between socio-economic status (SES) and clinical and biochemical factors related to coronary heart disease, in a sample of cardiovascular disease-free men and women. DESIGN: Cross-sectional survey. METHODS: During 2001-2002, 1514 men (20-87 years old) and 1528 women (20-89 years old) from the Attica region (Greece) were randomly enrolled into the study. Trends in established and emerging cardiovascular risk factors were examined across the participants' socio-economic status. A special index was developed (years of school by annual income) and three socio-economic classes were created. RESULTS: An inverse relationship was found regarding all lipids and glucose levels across the tertiles of the SES index. An inverse association was observed between body mass index, waist-to-hip ratio and SES in men, but not in women. Furthermore, compared to the lowest tertile, individuals who were classified in the highest SES tertile had lower levels of C-reactive protein, fibrinogen, homocysteine, tumour necrosis factor-alpha, interleukin-6 levels and white blood cell counts, even after adjusting for various potential confounders. Finally, a considerable proportion of men and women reported lack of health knowledge and education. CONCLUSIONS: An inverse association between SES and factors related to cardiovascular risk exists, but the causal pathway itself requires more detailed explanation before the social status can have explanatory power.