Artikel
Sex differences in cardiovascular risk in relation to socioeconomic position in the NAKO study
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Autoren
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Ilais Moreno
- Max-Delbrück-Centrum für Molekulare Medizin (Max Delbrück Center), Berlin, Germany
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Sanne Peters
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
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Nico Dragano
- Institut für Medizinische Soziologie, Centre for Health and Society, Universitätsklinikum Düsseldorf, Düssedorf, Germany
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Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Marcus Doerr
- Department of Internal Medicine, University Medicine Greifswald, Greifswald, Germany
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Beate Fischer
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
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Renate Schnabel
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Kardiologie - Universitäres Herz- und Gefäßzentrum, Hamburg, Germany
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Matthias Nauck
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
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susanne goettlicher
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Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Susanne Rospleszcz
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Stefan N. Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Lilian Krist
- Charité – Universitätsmedizin Berlin, Berlin, Germany
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Matthias B. Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
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Sylvia Gastell
- Deutsches Institut für Ernährungsforschung, Nuthetal, Germany
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Tilman Brand
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Germany
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Kathrin Günther
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Tamara Schikowski
- IUF - Leibniz Institute for Environmental Medicine, Düsseldorf, Germany
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Carina Emmel
- Universitätsklinikum Essen, Essen, Germany
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Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE)University Hospital of Essen (AöR), Essen, Germany
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Karin B. Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Rafael Mikolajczyk
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Alexander Kluttig
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Volker Harth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg, Germany
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Nadia Obi
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Stefanie Castell
- Helmholtz-Zentrum für Infektionsforschung, Braunschweig, Germany
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Carolina J. Klett-Tammen
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
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Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany
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Heiko Becher
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
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Volker Winkler
- Heidelberg Institute of Global Health Heidelberg University Hospital, Heidelberg, Germany
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Heike Minnerup
- Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Germany
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André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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Claudia Meinke-Franze
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Michael F. Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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Michael J. Stein
- Universität Regensburg, Regensburg, Germany
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Barbara Bohn
- NAKO e.V., Heidelberg, Germany
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Ben Schoettker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Kira trares
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Tobias Pischon
- Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
| Veröffentlicht: | 6. September 2024 |
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Gliederung
Text
Background: Social deprivation has been consistently associated with cardiovascular disease (CVD) risk, however the underlying mechanisms remain elusive and may manifest differently across sexes. We aimed to investigate sex differences in the association of two indicators of socioeconomic position (SEP) (education and relative income) with preexisting CVD, risk factors for CVD, and estimated cardiovascular risk. Further, we examined to what extent differences in CVD risk factors across SEP and sex may account for differences in the relationships of SEP with estimated cardiovascular risk between sexes.
Methods: A total of 204,780 (50.5% women) participants from the baseline examination of population-based German National Cohort (NAKO) were included. Logistic, multinomial, and linear regression age-adjusted models were used to estimate sex-specific odds ratios (OR) and beta-coefficients with 95% confidence intervals (CI) of self-reported CVD (myocardial infarction (MI), angina pectoris, heart failure, arrythmias, intermittent claudication, hypertension, stroke), and CVD risk factors (diabetes mellitus, hyperlipidemia, smoking status, alcohol consumption, family history of MI, systolic and diastolic-blood pressure, waist circumference, body fat percentage, body mass index, triglyceride, total-,LDL-, and HDL-cholesterol, glycated hemoglobin, and high-sensitivity C-reactive protein). In the population age 40-69 years without previous CVD and diabetes mellitus (n=143,019, 51.7% women), logistic regression models were used to obtain sex-specific OR and 95%-CI of very high-risk score (SCORE-2) associated with SEP. A very high 10-year CVD risk was defined as a predicted 10-year CVD risk ≥7.5% (age 40-49 years) or ≥10% (age 50-69 years). Women-to-men ratios of ORs (RORs) with 95%-CI were estimated. The interaction terms of SEP with sex were used to obtain the women-to men ROR for each SEP category.
Results: In women compared to men, low versus high educational attainment and income were more strongly associated with prevalent MI, hypertension, obesity, overweight, elevated blood pressure, antihypertensive medication and alcohol consumption, but less strong related to smoking. Analysis using relative income as exposure yielded largely similar findings, yet in women compared to men, low versus high income was more strongly associated with angina pectoris. The frequency of a very high predicted 10-year risk for CVD was higher in men than women: 4.22% vs. 0.07% (age-group 40-49) and 23.00% vs. 2.68% (age-groups 50-69). In women with the lowest vs. highest educational level, the OR for a very high 10-year CVD risk was 3.61 (95%-CI 2.88; 4.53), compared to 1.72 (95%-CI 1.51; 1.96) in men. The women-to-men-ROR was 2.33 (95%-CI 1.78; 3.05), attenuated after age-adjustments. For the comparison of low versus high relative income, the odds of having a very high 10-year CVD risk was 2.55 (95%-CI 2.04; 3.18) in women, and 2.25 (95%-CI 2.08; 2.42) in men (women-to-men ROR, 1.31 (95%-CI 1.05; 1.63).
Conclusion: Compared to high SEP, women with low SEP were more likely to have an unfavorable cardiovascular risk profile than equivalent men. In both sexes, there was an inverse graded association between SEP and the likelihood of having a very high 10-year CVD risk. This association was stronger in women indicating that cardiovascular risk is more dependent on SEP among women than among men.
Competing interests: RBS has received lecture fees and advisory board fees from BMS/Pfizer and Bayer outside this work
The authors declare that a positive ethics committee vote has been obtained.
