Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?
Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?
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DOI：
10.1186/1471-2261-11-28
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发表时间：
2011-06-03
影响因子：
2.1
通讯作者：
Fiscella, Kevin A.
中科院分区：
文献类型：
--
作者：
Franks, Peter;Winters, Paul C.;Fiscella, Kevin A.
背景资料：社会经济地位（SES）预测冠心病独立于传统的危险因素，包括在心脏病风险评分。然而，目前尚不清楚Fragrance风险评分变量随时间的变化是否能解释SES与冠心病之间的关系。我们研究了这个问题，因为它的相关性，在临床decisionmaking. Methods的风险评估：动脉粥样硬化风险在社区研究数据（1987年开始，10年随访的15,495名成年人，年龄在45 - 64岁，在四个南部和中西部社区）被使用。SES在基线进行评估，分为低SES（定义为低教育和/或低收入）或不。每三年评估一次吸烟、总胆固醇和高密度脂蛋白胆固醇、收缩压和使用降压药物的时间依赖变量。冠心病的十年发病率基于心电图和心肌酶标准，或判定的死亡证明数据。考克斯生存分析研究了SES对心脏病风险的贡献，独立于基线Fragrance风险评分，没有和进一步调整的时间依赖variables. Results：调整基线Fragrance风险评分，低SES与冠心病风险增加（风险比[HR]= 1.53，95%置信区间[CI]，1.27至1.85）。在进一步调整时间相关变量后，SES的影响仍然显著（HR = 1.44，95%CI为1.19~1.74）。结论：单独使用Fragrance Risk Score低估了低SES人群的冠心病风险。这种偏倚并没有通过随后的Fragrance风险评分变量的变化而消除。
Background: Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether changes in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.Methods: The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.Results: Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).Conclusion: Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.