Disclosures: De Bacquer reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
May 11, 2021
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Socioeconomic status linked to well-being, risk profiles in atherosclerotic CVD

Disclosures: De Bacquer reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Among patients with atherosclerotic CVD, better socioeconomic status was associated with better well-being and more favorable risk profiles for secondary prevention, researchers reported.

“This health inequality can be explained by differences in individual characteristics such as behavior or genetics, more contextual factors such as social and political environment (‘the causes of the causes’) and their interaction,” Dirk De Bacquer, MD, professor of epidemiology, research methodology and biostatistics in the department of public health and primary care at Ghent University, Belgium, and colleagues wrote in Heart. “The role of socioeconomic status in the context of the secondary prevention of ASCVD has been less described.”

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The paper examined 8,261 patients with CHD (74.2% men) aged 18 to 80 years from 27 countries from the EUROASPIRE study. Researchers constructed a socioeconomic status summary score based on patient education, self-perceived income, living situation and perception of loneliness.

Socioeconomic status and risk factors

In the cohort, 15% of patients had a lower educational level, 31% had self-perceived low family income, 13% were living alone and 6% reported feeling socially isolated. Low socioeconomic status was associated with smoking among men (OR = 1.63; 95% CI, 1.37-1.95), physical activity among men (OR = 1.51; 95% CI, 1.28-1.78) and women (OR = 1.77; 95% CI, 1.32-2.37) and obesity among men (OR = 1.28; 95% CI, 1.11-1.49) and women (OR = 1.65; 95% CI, 1.3-2.1).

Higher BP levels were observed among patients with low socioeconomic status for both men (OR = 1.24; 95% CI, 1.07-1.43) and women (OR = 1.31; 95% CI, 1.03-1.67), and these patients were less likely to use statins and demonstrated lower adherence to them. Patients with low socioeconomic status were less likely to attend cardiac rehabilitation programs or to be advised to attend them.

Researchers observed suboptimal access to statins in middle-income countries, with 21% of patients not on statins compared with 11% of patients in higher-income countries. This disparity led to 80% of patients not reaching a target of less than 1.8 mmol/L LDL.

There was also a strong association between a patients’ socioeconomic status and markers of well-being. A Hospital Anxiety and Depression Scale (HADS) anxiety score of at least 11 was associated with lower educational levels (men, 12%; women, 24%), lower self-perceived income (men, 14%; women, 23%), living alone (men, 12%; women, 16%) and loneliness (men, 22%; women, 28%). Lower educational level (men, 14%; women, 25%), lower self-perceived income (men, 12%; women, 19%), living alone (men, 10%; women, 12%) and loneliness (men, 8%; women, 21%) were also associated with a HADS depression score of at least 11.

Innovative strategies needed

According to the researchers, these findings may suggest a need for greater involvement of socioeconomic status characteristics in setting up personalized cardiac rehabilitation and preventive strategies.

“The results presented in this paper illustrate the complexity of the associations between socioeconomic status, well-being and secondary prevention in patients with CHD,” the researchers wrote. “It emphasizes the need for innovative strategies to prevent recurrent events and to improve well-being in patients with CHD with low socioeconomic status by integrating policies that facilitates accessibility to professional preventive services and to community networks.”