Socioeconomic Status and Subclinical Coronary Disease in the Whitehall II Epidemiological Study 英文参考文献.docVIP

SocioeconomicStatusandSubclinicalCoronaryDisease intheWhitehallIIEpidemiologicalStudy AndrewSteptoe1*,MarkHamer1,KatieO’Donnell1,ShreenidhiVenuraju2,MichaelG.Marmot1 ,Avijit Lahiri2 1Department ofEpidemiologyandPublicHealth, University CollegeLondon, London, United Kingdom, 2CardiacImaging andResearchCentre,WellingtonHospital, London,UnitedKingdom Abstract Background: There are pronounced socioeconomic disparities in coronary heart disease, but the extent to which these primarilyreflectgradientsinunderlyingcoronaryarterydiseaseseverityorintheclinicalmanifestationofadvanceddisease isuncertain.Wemeasuredtherelationshipbetweensocioeconomicstatus(SES)asindexedbygradeofemploymentand coronary artery calcification (CAC) in the Whitehall II epidemiological cohort, and tested the contribution of lifestyle, biologicalandpsychosocialfactorsinaccountingforthisassociation. Methods and Findings: CAC was assessed in 528 asymptomatic men and women aged 53–76 years, stratified into higher, intermediate and lower by grade of employment groups. Lifestyle (smoking, body mass index, alcohol consumption, physical activity), biological (blood pressure, lipids, fasting glucose, inflammatory markers) and psychosocial factors (work stress, financial strain, social support, depression, hostility, optimism) were also measured. Detectable CAC was present in 293 participants (55.5%). The presence of calcification was related to lifestyle and biological riskfactors, butnottogradeofemployment. Butamongindividuals withdetectable calcification, theseverity ofCACwasinversely associated withgrade ofemployment (p=0.010), andthisrelationship remained after controlling for demographic, lifestyle, biological and psychosocial factors. Compared with the higher grade group, there was a meanincrease inlogAgatstonscoresof0.783(95%C.I.0.265–1.302, p=0.003)intheintermediate and0.941(C.I.0.226– 1.657, p=0.010) inthelower grade ofemployment groups, after adjustment fordemographic, lifestyle,