Socioeconomic and marital status may be associated with an increased risk for second MI among MI survivors, according to results published in the European Journal of Preventive Cardiology.
“The novel finding of this large nationwide cohort study is that low [socioeconomic status] and marital status predict [recurrent atherosclerotic] CVD in 1-year survivors after a first MI. Disposable income, educational level and marital status were all associated with recurrence,” Joel Ohm, MD, a PhD student at Karolinska Institute in Stockholm, and colleagues wrote. “The association between disposable income and [recurrent atherosclerotic] CVD was independent of relevant cardiovascular risk factors and secondary preventive treatment. The findings are important for risk prediction within the large population with established cardiovascular disease and encourage further studies on the mediators of the effect of [socioeconomic status] on outcomes.”
Ohm and colleagues studied 29,226 men and women aged 40 to 76 years who were included in the SWEDEHEART registry.
The researchers obtained personal-level data on socioeconomic status, measured by disposable income and educational level, as well as marital status, and the primary endpoint — first recurrent event of atherosclerotic CVD — defined as nonfatal MI or CHD death or fatal or nonfatal stroke.
During a mean 4.1-year follow-up, 7.8% of patients experienced first recurrent manifestations of atherosclerotic CVD.
There was a link between both socioeconomic status indicators and marital status and the primary endpoint in multivariable Cox regression models.
A comprehensively adjusted model including secondary preventive treatment showed that the HR for the highest vs. lowest quintile of disposable income was 0.73 (95% CI, 0.63-0.43).
There was a stronger association between disposable income and first recurrent manifestation of atherosclerotic CVD among men, and the risk associated with being unmarried was also stronger in men than women (P for interaction < .05 for both).
According to Ohm and colleagues, the findings from this study should be interpreted with caution.
“We cannot conclude that women are better off being single and that men should marry and not divorce. Unmarried women had a higher level of education compared to unmarried men, and this difference in socioeconomic status may be the underlying cause,” Ohm said in a press release. “The take-home message from this study is that socioeconomic status and marital status is associated with recurrent events. No matter the reasons why, doctors should include socioeconomic status when assessing a heart attack survivor risk of recurrent event. More intense treatment could then be targeted to high-risk groups.” − by Dave Quaile
Disclosures: The authors report no relevant financial disclosures.
Editor’s Note: This article was modified on April 20, 2018 to reflect updates to the data.