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Socioeconomic Status, Pathogen Burden, and Cardiovascular Disease Risk
  1. Andrew Steptoe (a.steptoe{at}
  1. University College London, United Kingdom
    1. Alireza Shamaei-Tousi (ashamaei{at}
    1. Eastman Dnetal Institute, UCL, United Kingdom
      1. Asa Gylfe (asa.gylfe{at}
      1. Umeå University, Sweden
        1. Brian Henderson (b.henderson{at}
        1. Eastman Dental Institute, UCL, United Kingdom
          1. Sven Bergstrom (sven.bergstrom{at}
          1. Umeå University, Sweden
            1. Michael Marmot (m.marmot{at}
            1. University College London, United Kingdom


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

              Design: Cross-sectional observational study.

              Setting: Clinical examination of population sample

              Participants: 451 men and women aged 51-72 without CHD, recruited from the Whitehall II epidemiological cohort.

              Main outcome measures: SES was defined by grade of employment, and pathogen burden by summing positive serostatus for Chlamydia pneumoniae, cytomegalovirus (CMV), 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 (BMI), waist/hip ratio, blood pressure and incidence of diabetes. There were SES differences in waist/hip ratio, high density lipoprotein (HDL)-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.

              • Coronary heart disease
              • Pathogen burden
              • Risk factors
              • Socioeconomic status

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