Does Socioeconomic Status Influence the Risk of Subclinical Atherosclerosis? A Mediation Model

被引:19
作者
Redondo-Bravo, Lidia [1 ,2 ]
Miguel Fernandez-Alvira, Juan [2 ]
Gorriz, Juan [2 ,3 ]
Maria Mendiguren, Jose [4 ]
Sanz, Javier [2 ,5 ]
Fernandez-Friera, Leticia [2 ,6 ]
Manuel Garcia-Ruiz, Jose [2 ,7 ,8 ]
Fernandez-Ortiz, Antonio [2 ,7 ,9 ,10 ]
Ibanez, Borja [2 ,7 ,11 ]
Bueno, Hector [2 ,7 ,10 ,12 ]
Fuster, Valentin [2 ,5 ]
机构
[1] Hosp Univ La Paz, Prevent Med & Publ Hlth Dept, Madrid, Spain
[2] Ctr Nacl Invest Cardiovasc Carlos III CNIC, Melchor Fernandez Almagro 3, Madrid 28029, Spain
[3] Hosp Getafe, Cardiol Dept, Getafe, Spain
[4] Banco Santander, Madrid, Spain
[5] Icahn Sch Med Mt Sinai, New York, NY 10029 USA
[6] Hosp Madrid, Madrid, Spain
[7] CIBER Enfermedades Cardiovasc, Madrid, Spain
[8] ISPA Hosp Univ Cent Asturias, Oviedo, Spain
[9] Hosp Clin San Carlos, IdISSC, Cardiol Dept, Madrid, Spain
[10] Univ Complutense Madrid, Fac Med, Madrid, Spain
[11] IIS Fdn Jimenez Diaz Hosp, Madrid, Spain
[12] Hosp Univ 12 Octubre, Dept Cardiol, Inst Invest Imas12, Madrid, Spain
基金
欧盟地平线“2020”;
关键词
atherosclerosis; education; mediation model; smoking; socioeconomic status; CARDIOVASCULAR-DISEASE; LIFE-STYLE; UNITED-STATES; TOBACCO USE; EDUCATION; HEALTH; INCOME; PATTERNS; SWEDISH; WOMEN;
D O I
10.1016/j.jacc.2019.05.042
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Socioeconomic status (SES)-education, income level, and occupation-is associated with cardiovascular risk. OBJECTIVES This study aimed to investigate the association between SES and subclinical atherosclerosis and the potential mechanisms involved. METHODS SES, lifestyle habits (smoking, dietary patterns, physical activity, and hours of sleep), traditional risk factors, and subclinical atherosclerosis extent were prospectively assessed in 4,025 individuals aged 40 to 54 years without known cardiovascular disease enrolled in the PESA (Progression of Early Subclinical Atherosclerosis) study. After factors associated with atherosclerosis were identified, a multiple mediation model was created to quantify the effect of SES on subclinical atherosclerosis as explained by lifestyle behaviors. RESULTS Although education level was significantly associated with the presence of atherosclerosis, no differences were found according to income level in this population. Participants with lower education presented with a higher risk of generalized atherosclerosis than those with higher education (odds ratio: 1.46; 95% confidence interval: 1.15 to 1.85; p = 0.002). Lifestyle behaviors associated with both education level and atherosclerosis extent were: smoking status, number of cigarettes/day, and dietary pattern, which explained 70.5% of the effect of SES on atherosclerosis. Of these, tobacco habit (smoking status 35% and number of cigarettes/day 32%) accounted for most of the explained differences between groups, whereas dietary pattern did not remain a significant mediator in the multiple mediation model. CONCLUSIONS Despite the relative economic homogeneity of the cohort, lower education level is associated with increased subclinical atherosclerosis, mainly mediated by the higher and more frequent tobacco consumption. Smoking cessation programs are still needed, particularly in populations with lower education level. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
引用
收藏
页码:526 / 535
页数:10
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