Socioeconomic Status Linked with Subclinical Atherosclerosis

Socioeconomic status (education, income level, and occupation) was associated with sub-clinical atherosclerosis, according to a new study in the Journal of the American College of Cardiology.

The analysis out of Spain included 4,025 individuals between 40 and 54 years without known cardiovascular disease from the Progression of Early Subclinical Atherosclerosis (PESA) study. The researchers identified socioeconomic status of participants, along with lifestyle habits such as smoking, dietary patterns, physical activity, and hours of sleep, and then employed a multiple mediation model to quantify the effect of socioeconomic status on subclinical atherosclerosis.

The results suggested that education level was a significant factor associated with the presence of atherosclerosis. The researchers reported no differences due to income level in this patient population. Lower education levels were associated with a higher risk for generalized atherosclerosis compared to those with higher education levels (P=0.002). Smoking status was strongly linked to subclinical atherosclerosis, along with dietary patterns (70.5% of the effects of socioeconomic status were due to either smoking or diet). Tobacco habit (and the number of cigarettes per day) accounted for most of the differences between groups. Dietary patterns were not a significant mediator after the multiple mediation model.

“Despite the relative economic homogeneity of the cohort, lower education level is associated with increased subclinical atherosclerosis, mainly mediated by the higher and more frequent tobacco consumption,” the authors wrote in their abstract. “Smoking cessation programs are still needed, particularly in populations with lower education level.”

Education Matters

The researchers did note that the PESA study population did have a higher income level overall than the national average, but that education was still one of the most important factors associated with atherosclerosis.

“It is relevant that education still plays a role in the risk of atherosclerosis even in groups with a medium-high and high economic status,” they wrote in their study. “So, even when subjects have a good access to health care resources (Spain has a tax-based social security system covering the majority of the population) and present a favorable economic situation, such as in our cohort, education still acts as a decisive factor in CVD risk.”