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Heart 2007;93:1567-1570 doi:10.1136/hrt.2006.113993
  • Original research
  • Epidemiology

Socioeconomic status, pathogen burden and cardiovascular disease risk

  1. A Steptoe1,
  2. A Shamaei-Tousi2,
  3. Å Gylfe3,
  4. B Henderson2,
  5. S Bergström3,
  6. M Marmot1
  1. 1
    Department of Epidemiology and Public Health, University College London, London, UK
  2. 2
    Division of Microbial Diseases, Eastman Dental Institute, University College London, London, UK
  3. 3
    Department of Molecular Biology, Umeå University, Umeå, Sweden
  1. Professor Andrew Steptoe, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK; a.steptoe{at}ucl.ac.uk
  • Accepted 20 March 2007
  • Published Online First 8 May 2007

Abstract

Objective: Socioeconomic status (SES) is inversely associated with coronary heart disease (CHD) risk. Cumulative pathogen burden may also predict future CHD. The hypothesis was tested that lower SES is associated with a greater pathogen burden, and that pathogen burden accounts in part for SES differences in cardiovascular risk factors.

Methods: This was a cross-sectional observational study involving the clinical examination of 451 men and women aged 51–72 without CHD, recruited from the Whitehall II epidemiological cohort. SES was defined by grade of employment, and pathogen burden by summing positive serostatus for Chlamydia pneumoniae, cytomegalovirus and herpes simplex virus 1. Cardiovascular risk factors were also assessed.

Results: Pathogen burden averaged 1.94 (SD) 0.93 in the lower grade group, compared with 1.64 (0.97) and 1.64 (0.93) in the intermediate and higher grade groups (p = 0.011). Pathogen burden was associated with a higher body mass index, waist/hip ratio, blood pressure and incidence of diabetes. There were SES differences in waist/hip ratio, high-density lipoprotein-cholesterol, fasting glucose, glycated haemoglobin, lung function, smoking and diabetes. The SES gradient in these cardiovascular risk factors was unchanged when pathogen burden was taken into account statistically.

Conclusions: Although serological signs of infection with common pathogens are more frequent in lower SES groups, their distribution across the social gradient does not match the linear increases in CHD risk present across higher, intermediate and lower SES groups. Additionally, pathogen burden does not appear to mediate SES differences in cardiovascular risk profiles.

Footnotes

  • Funding: This research was supported by the British Heart Foundation and the Medical Research Council, UK. Västerbotten county council provided financial support for Dr Gylfe. The funding source has not been involved in the submission of the manuscript or in the decision to publish the data.

  • Competing interests: None.

  • Abbreviations:
    AU
    arbitrary unit
    BMI
    body mass index
    BP
    blood pressure
    CHD
    coronary heart disease
    CMV
    cytomegalovirus
    FEV1
    forced expiratory volume in 1 s
    HbA1c
    glycated haemoglobin
    HDL
    high-density lipoprotein
    HSV-1
    herpes simplex virus 1
    IgG
    immunoglobulin G
    SES
    socioeconomic status

Responses to this article

  • Authors' Response
    • Andrew Steptoe,
    • Julian Halcox, Wales Heart Research Institute
    Heart published online January 27, 2008
  • Socioecomonic status and cardiovascular disease risk
    • Jolanta Mieczkowska,
    • Jerzy Mosiewicz
    Heart published online January 7, 2008

This Article

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  4. All versions of this article:
    1. hrt.2006.113993v1
    2. 93/12/1567 most recent

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