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• Authors' Response
  Andrew Steptoe
  Published on: 23 November 2015
• Socioecomonic status and cardiovascular disease risk
  Jolanta Mieczkowska
  Published on: 23 November 2015

• Published on: 23 November 2015

  Authors' Response

  • Andrew Steptoe
  • Other Contributors:
    • Julian Halcox, Wales Heart Research Institute

  Dear Editor,

  We thank Drs Mieczkowska and Mosiewicz for their interest in our research on socioeconomic status (SES), pathogen burden and cardiovascular disease risk. They rightly highlight the strong social gradient in cardiovascular disease that is present in many European countries and is increasingly apparent world wide.1 Our study used employment grade as the indicator of SES, and it is interesting that sim...

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  Dear Editor,

  We thank Drs Mieczkowska and Mosiewicz for their interest in our research on socioeconomic status (SES), pathogen burden and cardiovascular disease risk. They rightly highlight the strong social gradient in cardiovascular disease that is present in many European countries and is increasingly apparent world wide.1 Our study used employment grade as the indicator of SES, and it is interesting that similar patterns emerge in Poland with level of education as the marker of social position. The social gradient is not fixed, since there was a positive association between SES and cardiovascular disease in the UK before the 2nd World War, shifting to an inverse gradient in the post war era.2 Drs Mieczkowska and Mosiewicz also point out the important role of adverse lifestyle factors such as smoking and obesity in maintaining the SES gradient.

  Our data on pathogens relate to cardiovascular risk factors such as adiposity, blood pressure and diabetes. However, we have recently had the opportunity to study a more direct measure of vascular pathophysiology in this population, namely arterial stiffness. Carotid arterial stiffness was measured using ultrasonography in conjunction with the Vascular Physiology Unit at the Institute of Child Health, University College London. The distensibility coefficient was calculated from the distension of the common carotid artery 1 cm proximal to the carotid bifurcation and simultaneous blood pressure data using standard formulae,3 with larger distensibility coefficients indicating lower arterial stiffness. Half the participants (50.8%) were seropositive for cytomegalovirus (CMV), and they had significantly lower distensibility coefficients than the remainder of the sample, with average levels of 14.77 (SD 4.2) 10-3kPa-1 compared with 15.71 (SD 5.2) 10-3kPa-1 after adjustment for age, gender, body mass index, waist/hip ratio, smoking, blood pressure and high density lipoprotein-cholesterol (p = 0.041). This indicates that carotid stiffness is greater among individuals with a history of CMV infection. CMV seropositivity was also more common among individuals of lower SES (indexed by grade of employment).4 But interestingly, when SES was included as a covariate in the analysis, the association between CMV seropositivity and arterial stiffness remained significant (p = 0.050), endorsing the conclusion of our article that the risks associated with infection history and lower SES are somewhat independent of one another.

  REFERENCES

  1. Avendano M, Kunst AE, Huisman M, et al.
  Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s.
  Heart 2006;92:461-7.

  2. Marmot MG, Adelstein AM, Robinson N, Rose GA.
  Changing social class distribution of heart disease.
  Br Med J 1978;ii:1109-1112.

  3. Dijk JM, Algra A, van der Graaf Y, Grobbee DE, Bots ML.
  Carotid stiffness and the risk of new vascular events in patients with manifest cardiovascular disease. The SMART study.
  Eur Heart J 2005;26:1213-20.

  4. Steptoe A, Shamaei-Tousi A, Gylfe A, Henderson B, Bergstrom S, Marmot M.
  Socioeconomic status, pathogen burden and cardiovascular disease risk.
  Heart 2007;93:1567-70.

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  Conflict of Interest:
  None declared.

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• Published on: 23 November 2015

  Socioecomonic status and cardiovascular disease risk

  • Jolanta Mieczkowska, the cardiologist
  • Other Contributors:
    • Jerzy Mosiewicz

  Dear Editor,

  We congratulate Dr A Steptoe and associates on their extensive epidemiological research concerning the cardiovascular risk and its association with the pathogen burden depending on the socio-economic status (1). Since the middle of the 20th century, the cardiovascular risk in the populations of Europe and the United States has shown a reverse dependence on the economic and professional status. Many rese...

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  Dear Editor,

  We congratulate Dr A Steptoe and associates on their extensive epidemiological research concerning the cardiovascular risk and its association with the pathogen burden depending on the socio-economic status (1). Since the middle of the 20th century, the cardiovascular risk in the populations of Europe and the United States has shown a reverse dependence on the economic and professional status. Many researchers including the authors of this study have attempted to find the causes of this tendency (2). The study referred to provides a lot of epidemiological information about the role played in vasculitis and the pathogenesis of atherosclerosis by the universally appearing infectious factors. The idea of associating the infectious factors initiating inflammatory changes in vessels influencing the development of atheroclerosis with the socio-economic status is inventive and interesting.

  Examinations were conducted on 1201 patients aged 40-60 selected from the population of Lublin (Poland), (3). Obesity and overweight were the most frequent cardiovascular risk factors. The most frequent occurrence of this disease was noted among patients with primary education, the fewest among those with higher education. Similarly, it was proved that the lower the patients' level of education, the greater and more severe the cigarette smoking habit. Hence the cardiovascular risk factors regarded as the indicators of social stress (obesity, smoking) occurred more frequently among the least educated patients. Moreover, the social stress is believed to belong to the obesity and smoking causes in the final phase. Having assessed the total cardiovascular risk, we observed the existence of higher level coronary artery disease risk in patients with vocational education as compared to people with higher education.

  Our findings accord with those recorded and currently observed in many European countries, where researchers have noticed a reverse dependence of the coronary artery disease on high standard of living. Consequently, there are more cases of the disease among lower social classes. Identifying the causes of this tendency will allow for designing better therapy and prevention strategies. My presentation and discussion of dr A Steptoe's research aims at finding the underlying cause of this tendency.

  References

  1. Steptoe A, Shamaei-Tousi A, Gylfe A et. al.
  Socioeconomic status, pathogen burden and cardiovascular disease risk.
  Heart. 2007; 93:1567-70.

  2. Bunde J Suls J.
  A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors.
  Health Psychol Psychoz 2006;25:493-500.

  3. Mieczkowska J, Baraniak J, Kozak-Szkopek E.
  The influence of education on the cardiovascular risk.
  Annales Universitatis Mariae Curie-Sk³odowska Sectio D-Medicina 2006; 61(1): 290-295,

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  Conflict of Interest:
  None declared.

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