Socioeconomic status: A powerful but still neglected modulator of cardiovascular risk

Despite the availability of effective therapeutic tools to significantly reduce cardiovascular risk (CVR) in Europe, a disturbing number of patients with cardiovascular disease (CVD) or people at high CVR do not achieve the guideline recommended standards for secondary prevention. In particular, their adoption of healthy lifestyles and adherence to cardioprotective medication are not appropriate.1–3 These interventions are the cornerstones of primary and secondary CVD prevention and are highly effective, regardless of the underlying individual genetic risk.4 The components of a healthy lifestyle (not smoking, regular physical exercise, healthy diet, weight control) have been well known by the public for decades and are repeatedly presented in magazines and newspapers. To understand and overcome this resistant discrepancy between scientific and public knowledge on the one hand and individual behaviour on the other, we need to focus on the psychological and social modulators of CVR. Against this background, in a well-defined cohort of 29,226 patients (27% women) who had survived their first acute myocardial infarction (AMI) for one year (secondary prevention quality registry of SWEDEHEART 2006–2014), the association of subsequent cardiovascular events with the patients’ socioeconomic status (SES) was evaluated.5,6 The SES was estimated by the patient’s disposable income (DINC), level of education and marital status. The primary endpoint was defined as the first recurrent CVD event (non-fatal AMI, CVD death, fatal or non-fatal stroke) during follow-up. For statistical evaluation, three models were used by adjusting for sex, age and calendar year at baseline (model 1), adding common CVR behaviours and risk diseases in the calculations (model 2) and then including secondary preventive treatment variables (model 3).