Year: 2019
Type: article
Abstract: 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.
Institutions: Hospital Universitario La Paz, Spanish National Centre for Cardiovascular Research, Hospital Universitario de Getafe, Banco Santander (Spain), Icahn School of Medicine at Mount Sinai, Centro de Investigación en Red en Enfermedades Cardiovasculares, Centro de Investigación Biomédica en Red, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Research Institute Hospital 12 de Octubre, Hospital Universitario 12 De Octubre
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $3,000
Funders: American Heart Association, Abbott Laboratories, Bristol-Myers Squibb, AstraZeneca, Bayer, Novartis, European Commission, Centro Nacional de Investigaciones Cardiovasculares, Ministerio de Asuntos Económicos y Transformación Digital, Gobierno de España, Servier, Horizon 2020 Framework Programme, Instituto de Salud Carlos III, European Regional Development Fund, Janssen Pharmaceuticals
Awards: G3474301475, G3715599165, G434337789, G441766136, G4681316006, G5454720240, G7234989988, Comprehensive Lifestyle Intervention Project (CLIP), G7847298077, Valoración de la enfermedad subclínica del miocardio mediante resonancia magnética cardiaca y su asociación con la carga de ateroesclerosis: subestudio de PESA
OpenAlex ID: W2963023017