Socioeconomic status, education, and aortic stiffness progression over 5 years: the Whitehall II prospective cohort study.

Xavier Trudel,Martin J Shipley,Carmel M Mceniery,Ian B Wilkinson,Eric J Brunner

doi:10.1097/hjh.0000000000001057

Abstract

Objective:The inverse association between socioeconomic status (SES) and cardiovascular disease (CVD) risk is well documented. Aortic stiffness assessed by aortic pulse wave velocity (PWV) is a strong predictor of CVD events. However, no previous study has examined the effect of SES on arterial stiffening over time. The present study examines this association, using several measures of SES, and attained education level in a large ageing cohort of British men and women.Methods:Participants were drawn from the Whitehall II study. The sample was composed of 3836 men and 1406 women who attended the 2008–2009 clinical examination (mean age = 65.5 years). Aortic PWV was measured in 2008–2009 and in 2012–2013 by applanation tonometry. A total of 3484 participants provided PWV measurements on both occasions. The mean difference in 5-year PWV change was examined according to household income, education, employment grade, and father's social class, using linear mixed models.Results:PWV increase [mean: confidence interval (m/s)] over 5 years was higher among participants with lower employment grade (0.38: 0.11–0.65), household income (0.58, 95%: 0.32–0.85), and education (0.30: 0.01, 0.58), after adjusting for sociodemographic variables, BMI, alcohol consumption, smoking, and other cardiovascular risk factors, namely SBP, mean arterial pressure, heart rate, cholesterol, diabetes, and antihypertensive use.Conclusion:The present study supports the presence of robust socioeconomic disparities in aortic stiffness progression. Our findings suggest that arterial aging could be an important pathophysiological pathway explaining the impact of lower SES on CVD risk.

Highlights

I n industrialized countries, cardiovascular diseases (CVD) are the leading causes of mortality [1] and generate important hospitalization costs [2]
The present study aims to examine the association between socioeconomic status (SES) and pulse wave velocity (PWV) progression, using several measures of SES, and attained education level in a large ageing cohort of British men and women
We examined whether sex and age modified the association between SES, education, and PWV change by fitting three-way interactions between these variables, the slope index of inequality (SII), and time since baseline and found no statistically significant interactions

Summary

Introduction

I n industrialized countries, cardiovascular diseases (CVD) are the leading causes of mortality [1] and generate important hospitalization costs [2]. A substantial body of evidence has demonstrated that low socioeconomic status (SES) is associated with cardiovascular mortality and morbidity [3]. The socioeconomic gap in CVD incidence has recently widened [4,5,6] and persists at older age [7]. Recent meta-analyses have reported a 15% increased CVD risk for each unit increase in PWV (1 m/s) [8] and an improved CVD risk prediction in different subgroups [9]. Aortic stiffness might be an important predictive summary measure that captures the effect of long-term exposure to a low SES over the life course on vascular ageing

Methods

Results

Discussion

Conclusion