Interrelations of Cumulative Social Risk, Silent Myocardial Infarction, and Mortality in the General Population

Abstract

Cumulative social risk (CSR), defined as experiencing more than one social risk factor, is associated with a significant increase in cardiovascular mortality. However, it is unclear whether CSR is associated with prevalent silent myocardial infarction (SMI), and whether their joint presence is predictive of mortality more than the presence of CSR in isolation. This analysis included 6,708 participants from the third National Health and Nutrition Examination Survey who were free of clinical cardiovascular disease at the time of enrollment. Baseline social risk factors (poverty-income ratio <1, minority race, education <12 grade, and living single) were used to create the CSR score with values ranging from 0 to ≥3. SMI was defined as electrocardiographic evidence of MI in the absence of clinical MI. In a multivariable-adjusted logistic regression model, baseline CSR ≥ 3 (vs 0) was associated with a higher prevalence of SMI (odds ratio [95% confidence interval]: 2.21 [1.16 to 4.23]). Over a median follow-up of 14 years, there were 2,151 all-cause deaths. Compared with CSR of 0 and no SMI, the risk of mortality with CSR was higher in the presence of SMI than without SMI (multivariable adjusted Hazard Ratios [95% confidence intervals] with vs without SMI were 1.76 [1.13 to 2.75] vs 1.27 [1.10 to 1.46] for CSR≥ 3; 2.06 [1.31 to 3.24] vs 1.21 [1.06 to 1.39] for CSR = 2; and 2.02 [1.31 to 3.12] vs 1.33 [0.63 to 2.82] for CSR = 1, respectively). In conclusion, exposure to CSR is associated with increased risk of SMI, and concomitant presence of SMI with CSR is associated with a higher risk of mortality than presence of CSR alone.