Article
Association between socioeconomic position and the progression of coronary artery calcification over 5 years
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Authors
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Julia Schwichtenberg
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Düsseldorf, Germany
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Carina Emmel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology Boston University, Boston, MA, United States of America, Boston, United States
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Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| Published: | September 6, 2024 |
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Outline
Text
Introduction: Social inequalities in cardiovascular disease, underlying atherosclerosis and coronary artery calcification (CAC) have been reported in different study populations. However, it has not been investigated whether socioeconomic position (SEP) has an impact on the progression of CAC over 5 years in a population-based cohort.
Methods: In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed using electron beam computed tomography (EBCT) at study baseline and after 5 years of follow-up in 3481 participants (age: 45-75 years, 53.1 % women). Education and household income at baseline were used as indicators of SEP. Education was defined as the total number of years of formal education according to the International Standard Classification of Education. Household income was measured as the equivalent income calculated from the total income (net) of a household and the number and age of people living in the household. Linear regression models including the natural logarithm of CAC after 5 years divided by CAC at baseline as outcome were used to calculate effect size estimates (% change) and 95% confidence intervals (95% CI) adjusted for age and sex as confounders and traditional cardiovascular risk factors (i.e., total cholesterol, hdl, bmi, smoking, systolic blood pressure, diabetes) as potential mediators.
Results: Additional 5 years of formal education were associated with on average 8.6% (95% CI: -16.1%; -0.5%) lower 5 year progression of CAC. When adjusting for traditional cardiovascular risk factors, the strength of the association remained (-8.2%, 95% CI: -15.6%; -0.05%). The results for using income as SEP indicator were comparable (4.6% lower CAC progression per 1000€ [95% CI: -9.6%; 0.7%], fully adjusted).
Conclusion: Results indicate an association of SEP with the severity of CAC progression: the higher years of formal education or household income at baseline, the lower the CAC progression over 5 years. This association appeared to be independent of the distribution of traditional cardiovascular risk factors (total cholesterol, hdl, bmi, smoking, systolic blood pressure, diabetes), so other SEP-related risk factors not considered in the analysis may be responsible for mediating the observed association.
The authors declare that they have no competing interests.
The authors declare that a positive ethics committee vote has been obtained.
