Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention

Giovanni Veronesi; Hugh Tunstall-Pedoe; Marco M Ferrario; Frank Kee; Kari Kuulasmaa; Lloyd E Chambless; Philippe Amouyel; Dominique Arveiler; Martin Bobak; Jean Ferrieres; Simona Giampaoli; Torben Jørgensen; Annette Peters; Veikko Salomaa; Stefan Soderberg; Abdonas Tamosiunas; Giancarlo Cesana; MORGAM Project

doi:10.1177/2047487316679521

Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention

Giovanni Veronesi, Hugh Tunstall-Pedoe, Marco M Ferrario, Frank Kee, Kari Kuulasmaa, Lloyd E Chambless, Philippe Amouyel, Dominique Arveiler, Martin Bobak, Jean Ferrieres, Simona Giampaoli, Torben Jørgensen, Annette Peters, Veikko Salomaa, Stefan Soderberg, Abdonas Tamosiunas, Giancarlo Cesana, MORGAM Project

Department of Public Health

28 Citations (Scopus)

Abstract

Background The combined effect of social status and risk factors on the absolute risk of cardiovascular disease has been insufficiently investigated, but results provide guidance on who could benefit most through prevention. Methods We followed 77,918 cardiovascular disease-free individuals aged 35-74 years at baseline, from 38 cohorts covering Nordic and Baltic countries, the UK and Central Europe, for a median of 12 years. Using Fine-Gray models in a competing-risks framework we estimated the effect of the interaction of education with smoking, blood pressure and body weight on the cumulative risk of incident acute coronary heart disease and stroke. Results Compared with more educated smokers, the less educated had an added increase in absolute risk of cardiovascular disease of 3.1% (95% confidence interval + 0.1%, +6.2%) in men and of 1.5% (-1.9%, +5.0%) in women, consistent across smoking categories. Conversely, the interaction was negative for overweight: -2.6% (95% CI: -5.6%, +0.3%) and obese: -3.6% (-7.6%, +0.4%) men, suggesting that the more educated would benefit more from the same reduction in body weight. A weaker interaction was observed for body weight in women, and for blood pressure in both genders. Less educated men and women with a cluster of two or more risk factors had an added cardiovascular disease risk of 3.6% (+0.1%, +7.0%) and of 2.6% (-0.5%, +5.6%), respectively, compared with their more educated counterparts. Conclusions Socially disadvantaged subjects have more to gain from lifestyle and blood pressure modification, hopefully reducing both their risk and also social inequality in disease.

Original language	English
Journal	European Journal of Preventive Cardiology
Volume	24
Issue number	4
Pages (from-to)	437-445
Number of pages	9
ISSN	2047-4873
DOIs	https://doi.org/10.1177/2047487316679521
Publication status	Published - 1 Mar 2017

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Veronesi, G., Tunstall-Pedoe, H., Ferrario, M. M., Kee, F., Kuulasmaa, K., Chambless, L. E., Amouyel, P., Arveiler, D., Bobak, M., Ferrieres, J., Giampaoli, S., Jørgensen, T., Peters, A., Salomaa, V., Soderberg, S., Tamosiunas, A., Cesana, G., & MORGAM Project (2017). Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention. European Journal of Preventive Cardiology, 24(4), 437-445. https://doi.org/10.1177/2047487316679521

Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts : Implications for prevention. / Veronesi, Giovanni; Tunstall-Pedoe, Hugh; Ferrario, Marco M et al.

In: European Journal of Preventive Cardiology, Vol. 24, No. 4, 01.03.2017, p. 437-445.

Research output: Contribution to journal › Journal article › Research › peer-review

Veronesi, G, Tunstall-Pedoe, H, Ferrario, MM, Kee, F, Kuulasmaa, K, Chambless, LE, Amouyel, P, Arveiler, D, Bobak, M, Ferrieres, J, Giampaoli, S, Jørgensen, T, Peters, A, Salomaa, V, Soderberg, S, Tamosiunas, A, Cesana, G & MORGAM Project 2017, 'Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention', European Journal of Preventive Cardiology, vol. 24, no. 4, pp. 437-445. https://doi.org/10.1177/2047487316679521

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title = "Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention",

abstract = "Background The combined effect of social status and risk factors on the absolute risk of cardiovascular disease has been insufficiently investigated, but results provide guidance on who could benefit most through prevention. Methods We followed 77,918 cardiovascular disease-free individuals aged 35-74 years at baseline, from 38 cohorts covering Nordic and Baltic countries, the UK and Central Europe, for a median of 12 years. Using Fine-Gray models in a competing-risks framework we estimated the effect of the interaction of education with smoking, blood pressure and body weight on the cumulative risk of incident acute coronary heart disease and stroke. Results Compared with more educated smokers, the less educated had an added increase in absolute risk of cardiovascular disease of 3.1% (95% confidence interval + 0.1%, +6.2%) in men and of 1.5% (-1.9%, +5.0%) in women, consistent across smoking categories. Conversely, the interaction was negative for overweight: -2.6% (95% CI: -5.6%, +0.3%) and obese: -3.6% (-7.6%, +0.4%) men, suggesting that the more educated would benefit more from the same reduction in body weight. A weaker interaction was observed for body weight in women, and for blood pressure in both genders. Less educated men and women with a cluster of two or more risk factors had an added cardiovascular disease risk of 3.6% (+0.1%, +7.0%) and of 2.6% (-0.5%, +5.6%), respectively, compared with their more educated counterparts. Conclusions Socially disadvantaged subjects have more to gain from lifestyle and blood pressure modification, hopefully reducing both their risk and also social inequality in disease.",

author = "Giovanni Veronesi and Hugh Tunstall-Pedoe and Ferrario, {Marco M} and Frank Kee and Kari Kuulasmaa and Chambless, {Lloyd E} and Philippe Amouyel and Dominique Arveiler and Martin Bobak and Jean Ferrieres and Simona Giampaoli and Torben J{\o}rgensen and Annette Peters and Veikko Salomaa and Stefan Soderberg and Abdonas Tamosiunas and Giancarlo Cesana and {MORGAM Project}",

year = "2017",

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doi = "10.1177/2047487316679521",

language = "English",

volume = "24",

pages = "437--445",

journal = "European Journal of Preventive Cardiology",

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T1 - Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts

T2 - Implications for prevention

AU - Veronesi, Giovanni

AU - Tunstall-Pedoe, Hugh

AU - Ferrario, Marco M

AU - Kee, Frank

AU - Kuulasmaa, Kari

AU - Chambless, Lloyd E

AU - Amouyel, Philippe

AU - Arveiler, Dominique

AU - Bobak, Martin

AU - Ferrieres, Jean

AU - Giampaoli, Simona

AU - Jørgensen, Torben

AU - Peters, Annette

AU - Salomaa, Veikko

AU - Soderberg, Stefan

AU - Tamosiunas, Abdonas

AU - Cesana, Giancarlo

AU - MORGAM Project

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background The combined effect of social status and risk factors on the absolute risk of cardiovascular disease has been insufficiently investigated, but results provide guidance on who could benefit most through prevention. Methods We followed 77,918 cardiovascular disease-free individuals aged 35-74 years at baseline, from 38 cohorts covering Nordic and Baltic countries, the UK and Central Europe, for a median of 12 years. Using Fine-Gray models in a competing-risks framework we estimated the effect of the interaction of education with smoking, blood pressure and body weight on the cumulative risk of incident acute coronary heart disease and stroke. Results Compared with more educated smokers, the less educated had an added increase in absolute risk of cardiovascular disease of 3.1% (95% confidence interval + 0.1%, +6.2%) in men and of 1.5% (-1.9%, +5.0%) in women, consistent across smoking categories. Conversely, the interaction was negative for overweight: -2.6% (95% CI: -5.6%, +0.3%) and obese: -3.6% (-7.6%, +0.4%) men, suggesting that the more educated would benefit more from the same reduction in body weight. A weaker interaction was observed for body weight in women, and for blood pressure in both genders. Less educated men and women with a cluster of two or more risk factors had an added cardiovascular disease risk of 3.6% (+0.1%, +7.0%) and of 2.6% (-0.5%, +5.6%), respectively, compared with their more educated counterparts. Conclusions Socially disadvantaged subjects have more to gain from lifestyle and blood pressure modification, hopefully reducing both their risk and also social inequality in disease.

AB - Background The combined effect of social status and risk factors on the absolute risk of cardiovascular disease has been insufficiently investigated, but results provide guidance on who could benefit most through prevention. Methods We followed 77,918 cardiovascular disease-free individuals aged 35-74 years at baseline, from 38 cohorts covering Nordic and Baltic countries, the UK and Central Europe, for a median of 12 years. Using Fine-Gray models in a competing-risks framework we estimated the effect of the interaction of education with smoking, blood pressure and body weight on the cumulative risk of incident acute coronary heart disease and stroke. Results Compared with more educated smokers, the less educated had an added increase in absolute risk of cardiovascular disease of 3.1% (95% confidence interval + 0.1%, +6.2%) in men and of 1.5% (-1.9%, +5.0%) in women, consistent across smoking categories. Conversely, the interaction was negative for overweight: -2.6% (95% CI: -5.6%, +0.3%) and obese: -3.6% (-7.6%, +0.4%) men, suggesting that the more educated would benefit more from the same reduction in body weight. A weaker interaction was observed for body weight in women, and for blood pressure in both genders. Less educated men and women with a cluster of two or more risk factors had an added cardiovascular disease risk of 3.6% (+0.1%, +7.0%) and of 2.6% (-0.5%, +5.6%), respectively, compared with their more educated counterparts. Conclusions Socially disadvantaged subjects have more to gain from lifestyle and blood pressure modification, hopefully reducing both their risk and also social inequality in disease.

U2 - 10.1177/2047487316679521

DO - 10.1177/2047487316679521

M3 - Journal article

C2 - 27837152

SN - 2047-4873

VL - 24

SP - 437

EP - 445

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 4

ER -

Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: Implications for prevention

Abstract

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