Socio-economic position and coronary heart disease risk factors in children and young people - Evidence from UK epidemiological studies

Background: Coronary heart disease (CHD) is a condition with its origin in early life. In adults, CHD and its risk factors show clear socio-economic gradients. The aim of the present review is to collate published evidence to assess if these risk factor gradients are also apparent in young people in the UK. Methods: Pertinent publications were identified in four ways: i) a systematic search of PUBMED from its inception in January 1966 until October 2000; ii) scanning the reference sections of identified publications; iii) searching the authors' own files; and iv) contacting experts in the field. Results: Of eleven CHD risk factors, consistent evidence concerning the association in child- and early adulthood with socio-economic position was evident for cigarette smoking, birth weight, adiposity (in young adults), height, and some aspects of diet, particularly fat and fibre consumption. As in UK adults, the most favourable levels of these risk factors were seen in young people from socially advantaged backgrounds. For the other variables associated with CHD - physical inactivity/low cardiorespiratory fitness, blood pressure, blood cholesterol, adiposity (in children), and some emerging risk factors (C-reactive protein, homocysteine, fibrinogen) - there was little evidence of any clear association with socio-economic level. Conclusions: While social variation is seen in some CHD risk factors in young people, further data are needed to fully explore if this is also the case for others. This issue could be addressed by analysing some existing but unutilized survey data from the UK.