Impact of traditional and novel risk factors on the relationship between socioeconomic status and incident cardiovascular events
Impact of traditional and novel risk factors on the relationship between socioeconomic status and incident cardiovascular events
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DOI：
10.1161/circulationaha.106.660043
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发表时间：
2006-12-12
期刊：
影响因子：
37.8
通讯作者：
Ridker, Paul M.
中科院分区：
文献类型：
--
作者：
Albert, Michelle A.;Glynn, Robert J.;Ridker, Paul M.
背景——社会经济地位较低的人比社会经济地位较高的人有更大的心血管风险。然而，社会经济地位影响心血管疾病（CVD）的机制尚不确定。事实上，没有数据可以检验新型炎症和止血性 CVD 风险指标、社会经济状况和 CVD 事件之间的前瞻性关联。方法和结果 - 我们评估了 22 688 名表面健康的女性卫生专业人员参与的研究，评估了 2 个社会经济状况指标（教育和收入）、传统和新型 CVD 风险因素（高敏 C 反应蛋白、可溶性细胞间粘附分子-1、纤维蛋白原和同型半胱氨酸）和 CVD 事件之间的关系。妇女健康研究。这些女性接受了为期 10 年的随访，了解心肌梗塞、缺血性中风、冠状动脉血运重建和心血管死亡的发生情况。受教育程度越高的女性吸烟的可能性越小；高血压、糖尿病和肥胖症的患病率较低；与受教育程度较低的女性相比，她们更有可能参加剧烈的体育活动。基线时，5类教育（<2年护理教育、2至<4年护理教育、学士、硕士学位和博士学位）和6类收入[= 100 000美元）女性的中位总胆固醇、低密度脂蛋白、C反应蛋白、细胞间粘附分子-1、纤维蛋白原和同型半胱氨酸水平随着教育或收入的增加而逐渐下降水平（所有 P < 0.001），而高密度脂蛋白则观察到相反的模式（P < 0.001）。总体而言，在年龄调整的 Cox 比例风险模型中，CVD 事件的相对风险随着教育类别（1.0、0.7、0.5、0.4 和 0.5；趋势 P < 0.001）和收入（1.0、1.0、0.9、0.7、0.6 和 0.4；趋势 P < 0.001）类别的增加而降低。在评估传统和新型 CVD 风险因素对教育/收入与 CVD 事件之间关系的影响的多变量模型中，与 1 类较高教育水平相关的 CVD 事件的相对风险从年龄和种族调整分析中的 0.79 变为完全调整分析中的 0.89。每 1 类教育的风险降低 11% 仍然显着（趋势 P = 0.006），这表明控制新的和传统的风险因素并不能解释教育的保护作用。对收入的类似分析表明，收入与 CVD 事件的关系很大程度上是由这些已知的风险因素来解释的。结论 - 在这项前瞻性分析中，我们观察到随着教育水平和收入的增加，CVD 事件的发生率有所下降。与收入和 CVD 事件之间的关系相反，CVD 事件与教育的关系只能部分地由 CVD 的传统和新型危险因素来解释。
Background - Persons of lower socioeconomic status have greater cardiovascular risk than those of higher socioeconomic status. However, the mechanism through which socioeconomic status affects cardiovascular disease (CVD) is uncertain. Virtually no data are available that examine the prospective association between novel inflammatory and hemostatic CVD risk indicators, socioeconomic status, and incident CVD events.Methods and Results - We assessed the relationship between 2 indicators of socioeconomic status ( education and income), traditional and novel CVD risk factors ( high sensitivity C-reactive protein, soluble intercellular adhesion molecule-1, fibrinogen, and homocysteine), and incident CVD events among 22 688 apparently healthy female health professionals participating in the Women's Health Study. These women were followed up for 10 years for the development of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death. More educated women were less likely to be smokers; had a lower prevalence of hypertension, diabetes, and obesity; and were more likely to participate in vigorous physical activity than less educated women. At baseline, median total cholesterol, low-density lipoprotein, triglyceride, C-reactive protein, intercellular adhesion molecule-1, fibrinogen, and homocysteine levels for women in 5 categories of education (< 2 years of nursing education, 2 to < 4 years of nursing education, a bachelor's degree, a master's degree, and a doctoral degree) and 6 categories of income [=$ 100 000) decreased progressively with increasing education or income levels (all P < 0.001), whereas an opposite pattern was observed for high-density lipoprotein ( P < 0.001). Overall, in age-adjusted Cox proportional hazards models, the relative risk of incident CVD events decreased with increasing education (1.0, 0.7, 0.5, 0.4, and 0.5; P for trend < 0.001) and income ( 1.0, 1.0, 0.9, 0.7, 0.6, and 0.4; P for trend < 0.001) categories. In multivariate models that assessed the impact of traditional and novel CVD risk factors on the relationship between education/income and CVD events, the relative hazard of incident CVD associated with a 1-category-higher level of education changed from 0.79 in age- and race-adjusted analysis to 0.89 in fully adjusted analysis. The 11% lower risk per 1 category of education remained significant ( P for trend = 0.006), suggesting that controlling for both novel and traditional risk factors could not explain the protective effect of education. A similar analysis for income revealed that its relationship with CVD events was explained largely by these noted risk factors.Conclusions - In this prospective analysis, we observed a decrease in incident CVD events with increasing levels of education and income. In contrast to the relationship between income and CVD events, the relationship of CVD events with education was explained only partially by traditional and novel risk factors for CVD.