Objective People’s socioeconomic status (SES) has a major impact on the risk of atherosclerotic cardiovascular disease (ASCVD) in primary prevention. In patients with existing ASCVD these associations are less documented. Here, we evaluate to what extent SES is still associated with patients’ risk profile in secondary prevention.
Methods Based on results from a large sample of patients with coronary heart disease from the European Action on Secondary and Primary Prevention through Intervention to Reduce Events study, the relationship between SES and cardiovascular risk was examined. A SES summary score was empirically constructed from the patients’ educational level, self-perceived income, living situation and perception of loneliness.
Results Analyses are based on observations in 8261 patients with coronary heart disease from 27 countries. Multivariate logistic regression analyses demonstrate that a low SES is associated (OR, 95% CI) with lifestyles such as smoking in men (1.63, 1.37 to 1.95), physical activity in men (1.51, 1.28 to 1.78) and women (1.77, 1.32 to 2.37) and obesity in men 1.28 (1.11 to 1.49) and women 1.65 (1.30 to 2.10). Patients with a low SES have more raised blood pressure in men (1.24, 1.07 to 1.43) and women (1.31, 1.03 to 1.67), used less statins and were less adherent to them. Cardiac rehabilitation programmes were less advised and attended by patients with a low SES. Access to statins in middle-income countries was suboptimal leaving about 80% of patients not reaching the low-density lipoprotein cholesterol target of <1.8 mmol/L. Patients’ socioeconomic level was also strongly associated with markers of well-being.
Conclusion These results illustrate the complexity of the associations between SES, well-being and secondary prevention in patients with ASCVD. They emphasise the need for integrating innovative policies in programmes of cardiac rehabilitation and secondary prevention.
- cardiac risk factors and prevention
Statistics from Altmetric.com
Contributors DW, GDB, KK, DDB were responsible for the conception and design of the study. DDB was responsible for the data analysis and interpretation. DDB and GDB drafted the article. All authors have critically revised the manuscript and gave final approval of the publication of this manuscript. DDB is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer Since the start of the EORP, the following companies have supported the programme: Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk. The sponsors of the EUROASPIRE surveys had no role in the design, data collection, data analysis, data interpretation, writing the manuscript and the decision to publish.
Competing interests The authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this paper: KK had grant support from the European Society of Cardiology.
Patient consent for publication Not required.
Ethics approval National Coordinators were responsible for obtaining Local Research Ethics Committees approvals. Written informed consent was obtained from each participant by the investigator by means of a signed declaration. The research assistants signed in the Case Record Form a confirmation that an informed consent was obtained and stored the original signed declaration consent in the patient file.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are publicly available. The EUROASPIRE V database is property of the EURObservational Research Programme of the European Society of Cardiology.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.