Autoimmune Disorders Connective tissue disease represents a less well-studied issue in SIHD. In rheumatoid arthritis, findings from at least one study show increased inflammation in the coronary artery walls, with increased frequency of vulnerable plaques.1205 Accelerated atherosclerosis in systemic lupus erythematosis, due to impaired endothelial function and novel atherogenic and thrombotic risk factors, requires special attention inas- much as the adjusted rate of SIHD in systemic lupus erythematosis is $50-fold higher than in patients without it.1206,1207 A younger population is more frequently affected in systemic lupus erythematosis,1208 and coronary artery spasm is a frequent complication in connective tissue disease.1209 5.12.8. Socioeconomic Factors Low socioeconomic status is highly associated with the risk of cardiovascular disease.1210 Men 30 to 59 years of age with low socioeconomic status are at 55% higher risk of death due to IHD than are those of higher status (RR: 1.55; 95% CI: 1.51 to 1.60), and the risk is .2-fold higher among women In addition to lower socioeconomic status being associated with a higher prevalence of IHD, it has been amply demon- strated that patients of lower socioeconomic status and those who are members of an ethnic or racial minority (in particular African Americans and Hispanics) are less likely to receive a wide variety of diagnostic and therapeutic interventions. These disparities have been observed with regard to cardiac procedures as well as access to cardiologists.1212 Moreover, African Americans and Hispanics are 10% to 40% less likely to receive outpatient secondary prevention therapies for cardiovascular disease.1213 Although lower rates of diagnostic and interventional services have not been adequately ex- plained,1214,1215 it is clear that individuals of lower socioeco- nomic status and ethnic minorities typically have fewer healthcare resources, have worse general health and cardiac risk profiles, and are less knowledgeable about SIHD symp- toms. 