Novel coronary heart disease risk factors at 60–64 years and life course socioeconomic position: The 1946 British birth cohort

Rebecca Jones,Rebecca Hardy,Naveed Sattar,John E Deanfield,Alun Hughes,Diana Kuh,Emily T Murray,Peter H Whincup,Claudia Thomas

doi:10.1016/j.atherosclerosis.2014.11.011

Abstract

Social disadvantage across the life course is associated with a greater risk of coronary heart disease (CHD) and with established CHD risk factors, but less is known about whether novel CHD risk factors show the same patterns. The Medical Research Council National Survey of Health and Development was used to investigate associations between occupational socioeconomic position during childhood, early adulthood and middle age and markers of inflammation (C-reactive protein, interleukin-6), endothelial function (E-selectin, tissue-plasminogen activator), adipocyte function (leptin, adiponectin) and pancreatic beta cell function (proinsulin) measured at 60–64 years. Life course models representing sensitive periods, accumulation of risk and social mobility were compared with a saturated model to ascertain the nature of the relationship between social class across the life course and each of these novel CHD risk factors. For interleukin-6 and leptin, low childhood socioeconomic position alone was associated with high risk factor levels at 60–64 years, while for C-reactive protein and proinsulin, cumulative effects of low socioeconomic position in both childhood and early adulthood were associated with higher (adverse) risk factor levels at 60–64 years. No associations were observed between socioeconomic position at any life period with either endothelial marker or adiponectin. Associations for C-reactive protein, interleukin-6, leptin and proinsulin were reduced considerably by adjustment for body mass index and, to a lesser extent, cigarette smoking. In conclusion, socioeconomic position in early life is an important determinant of several novel CHD risk factors. Body mass index may be an important mediator of these relationships.

Highlights

In the UK and other Western countries, social disadvantage across the life course is a strong determinant of coronary heart disease (CHD) risk [1e3]
We found strong evidence for associations between socioeconomic position and six of the seven novel CHD risk factors; individuals in lower socioeconomic position displayed more adverse levels of C-reactive protein, interleukin-6, E-selectin, proinsulin, leptin and adiponectin (Table 2)
Leptin and proinsulin were associated with socioeconomic position in childhood and early adulthood, though less clearly in middle-age; E-selectin and adiponectin were associated with childhood but not adult socioeconomic position

Summary

Introduction

In the UK and other Western countries, social disadvantage across the life course is a strong determinant of coronary heart disease (CHD) risk [1e3] Potential explanations for this socioeconomic gradient in CHD risk have centred on socioeconomic differences in the distribution of established risk factors, cigarette smoking, blood pressure, blood lipids and adiposity [4,5]. R. Jones et al / Atherosclerosis 238 (2015) 70e76 in the possibility that these novel CHD risk factors, inflammatory markers, may be mediators of the association between socioeconomic position and CHD risk [16e20]. Recent evidence suggests that markers of endothelial, adipocyte and pancreatic beta-cell function could represent biological pathways relating socioeconomic position and CHD risk [21,22]

Methods

Results

Conclusion