Differences In Incidence Of Coronary Heart Disease Research Articles

Changing associations of coronary heart disease incidence with current partnership status and marital history over three decades

Married men and women have better health than non-married, but little is known about how cohabitation and marital history are associated with coronary heart disease (CHD) incidence and how these associations have changed over time. We analyzed these associations by fitting Cox regression models to register data covering the whole Finnish population aged 35 years or older (N = 4,415,590), who experienced 530,560 first time non-fatal or fatal CHD events during the years 1990–2018. Further, we used stratified Cox regression models to analyze CHD incidence within same-sex sibling pairs (N = 377,730 pairs). Married men and women without previous divorce had the lowest CHD incidence whereas cohabitation and a history of divorce were associated with higher CHD incidence. The associations were stronger in younger (35–64 years old) than older participants (65 years or older). These associations remained after adjusting for several indicators of social position, and the lower CHD incidence among those married without previous divorce was also observed within sibling pairs with a shared family background. The differences in CHD incidence between the categories generally widened over time; the largest and most systematic widening was observed among women in the younger age category. The long standing negative effect of divorce suggests that selection may partly explain the association between partnership status and CHD incidence. Partnership status is an increasingly important factor contributing to social inequalities in health.

Differential susceptibility to allostatic load and educational inequalities in coronary heart disease

Abstract Background Differential exposure to lifestyle factors may mediate the association between education and cardiovascular disease (CVD). However, differential susceptibility (the effect of exposure to the same “dose” of risk factors differs across groups) may also elevate CVD risk but the causal pathways remain unclear. Allostatic Load (AL) is a marker of cumulative biological burden resulting from mal-adaptation to chronic stressors. We aimed to examine the role of differential exposure and susceptibility to AL and other factors in coronary heart disease (CHD) educational gradients in Europe. Methods 51,328 35-74-year-old participants originally free of CVD from 21 European cohorts in the BiomarCaRE consortium were identified and followed for a median of 10 years to their first CHD event. We defined an AL score as the sum of z-scores of 8 markers from the cardiovascular, metabolic, and inflammatory systems. To investigate the mediating role of AL (and smoking, alcohol and BMI) on educational differences in CHD incidence we applied marginal structural models and three-way decomposition on gender-specific additive hazards models. Results AL was a significant mediator of the association between educational status and CHD. The highest proportion mediated was observed in women, with 28% (95%CI 20% to 44%) attributable to differential exposure and 8% (95%CI 0% to 16%) to differential susceptibility. In men, AL mediated 16% of the increased CHD risk in the less educated, with 2% (95%CI 0%-6%) attributable to differential susceptibility. The effects of smoking, alcohol and BMI were relatively small for men and women, with a limited role of differential susceptibility. Conclusions While we found evidence of differential susceptibility to AL on CHD, effects were modest and the mediating effect of AL (and other lifestyle factors) was predominately via differential exposure. Controlling disproportionate exposure to AL may help reduce CHD morbidity among those with lower education. Key messages Educational inequalities in coronary heart disease in Europe were predominantly driven by differential exposure rather than susceptibility to allostatic load and other lifestyle factors. Controlling disproportionate exposure to AL may help reduce coronary heart disease morbidity among those with lower education.

The contribution of major risk factors and job strain to occupational class differences in coronary heart disease incidence: the MONICA Brianza and PAMELA population-based cohorts

ObjectivesWe investigated the contribution of major coronary heart disease (CHD) risk factors and job strain to occupational class differences in CHD incidence in a pooled-cohort prospective study in northern Italy.Methods2964...

Differences in lipoprotein particle subclass distribution for Japanese Americans in Hawaii and Japanese in Japan: The INTERLIPID Study

Current data suggest that low density lipoprotein (LDL) and high density lipoprotein (HDL) subclass concentrations relate directly to the risk of coronary heart disease (CHD). Earlier Studies indicated that Japanese in Japan had lower rates of CHD than Japanese Americans in Hawaii. Rates of CHD appear to continue to be lower in Japan despite increasing cholesterol levels in Japan and decreasing CHD rates in the United States. To provide insight into CHD rate differences. Nuclear Magnetic Resonance (NMR) measurements of lipoprotein subclasses were used to assess lipoprotein particle concentration and size in samples from these two genetically similar populations in Japan and Hawaii. Japanese Americans had significantly higher age- and risk factor- adjusted concentrations of lipoprotein particles implicated in atherogenesis, including large very low density lipoprotein (VLDL; P < 0.001), small LDL (P < 0.001), and small HDL (women, P < 0.001; men, P < 0.01), and significantly lower concentrations of large LDL (P < 0.001) and the putative cardio-protective large HDL (P < 0.05) than Japanese in Japan. Average age- and risk factor- adjusted LDL and HDL particle sizes were also significantly (P < 0.001) smaller in Japanese Americans. Adjustment for body mass index markedly reduced the differences in some lipoprotein measures, including total LDL and large HDL particle concentrations for both genders, total VLDL particle concentration for women, and large VLDL concentration and average HDL particle size for men. Differences in lipoprotein subclass distributions and lifestyle factors such as body weight may contribute to differences in CHD incidence for Japanese in Japan and Japanese Americans.

Decreased risk of death from coronary heart disease amongst men with higher 'femininity' scores: a general population cohort study

At all ages men have higher rates of coronary heart disease (CHD) than women, although similar proportions of men and women eventually die of CHD. Gender differences in CHD incidence and mortality are often explained in relation to biological (hormonal) and behavioural risk factors (e.g. smoking), but psychological factors and broader social constructions of gender are rarely considered. To examine the relationship between measures of gender role orientation at baseline in 1988 and mortality from CHD over 17 years (to June 2005). Prospective cohort study linked to national mortality reporting. Socially varied, mainly urban area centred on city of Glasgow in West Central Scotland, UK. In total, 1551 participants (704 men and 847 women) aged 55 years took part in detailed interviews with nurses trained in survey methods in 1988. These included a wide range of measures of physical development and functioning, self reported health and health behaviour, personal and social circumstances and a measure of gender role orientation (yielding scores for 'masculinity' and 'femininity'). Mortality from CHD up to June 2005 (88 CHD deaths in men; 41 CHD deaths in women). After adjusting for smoking, binge drinking, body mass index, systolic blood pressure, household income and psychological well-being, higher 'femininity' scores in men were associated with a lower risk of CHD death (hazards ratio per unit increase in 'femininity' score 0.65, 95% CIs 0.48-0.87, P = 0.004). No such relationship was observed amongst women. 'Masculinity' scores were unrelated to CHD mortality in either men or women. These results suggest that social constructions of gender influence the risk of ill health, here death from CHD. Men who are less able to identify themselves with characteristics identified as 'feminine' or expressive (who have a more limited stereotypically masculine self-image) may be at increased risk of coronary disease. Further research on the link between social constructions of gender and health is needed.

Low linking social capital as a predictor of coronary heart disease in Sweden: A cohort study of 2.8 million people

This study investigated the association between the recently minted concept of linking social capital and incidence of coronary heart disease (CHD). A follow-up study of 1,358,932 men and 1,446,747 women in Sweden aged 45–74 years was conducted between 1 January 1998 and 31 December 1999. Neighbourhood linking social capital was conceptualised as proportions of individuals voting in local government elections at neighbourhood level. The neighbourhood- and individual-level factors were analysed within a multilevel framework. Linking social capital was associated with CHD in both men and women beyond individual-level factors: in neighbourhoods with low linking social capital the odds ratios were 1.19 (CI=1.14–1.24) and 1.29 (CI=1.21–1.38) for men and women, respectively, after adjustment for age, country of birth, education, marital status, and housing tenure. The significant between-neighbourhood variance (i.e. the random intercept) showed significant differences in CHD incidence between neighbourhoods. Even in a relatively egalitarian society, as exemplified by the Swedish Welfare State, individual health is affected by differences between neighbourhoods in linking social capital. The use of linking social capital represents a novel conceptual advance in research on the association between CHD, one of the major causes of death in Western countries, and the multidimensional aspects of social capital.

Trends and Regional Differences in Coronary Risk Factors in Two Areas in Belgium: Final Results from the MONICA Ghent–Charleroi Study

To study regional differences and trends in coronary risk factors and in predicted coronary risk calculated on the basis of multiple logistic function equations for the general population aged 25-64 years in two areas in Belgium during the period 1985-1992. A comparison of cross-sectional data on coronary risk factors between two cities and different survey periods. In the cities of Ghent (in Flanders) and Charleroi (in Walloonia) in Belgium, three consecutive cross-sectional age-stratified and sex-stratified random samples of 2000 subjects each were selected from the general population. We studied their coronary risk factors between 1985 and 1992. The field work was carried out according to the protocol of the international WHO-MONICA project. We observed a significant decrease in the prevalence of smoking among men in the two cities over the three surveys, while a gradual increase in diastolic blood pressure for all subgroups in Ghent was seen (this was statistically significant for men aged 45-64 years and women aged 25-44 years). The overall coronary risk predicted on the basis of multiple-logistic-function equations did not however, exhibit significant trends over time in either city. Comparisons between the two centres revealed significantly higher mean serum levels of total cholesterol in Charleroi than in Ghent (for all subgroups except women aged 45-64 years) and significantly higher mean systolic blood pressures in Charleroi for all subgroups defined in terms of age and sex. Prevalences of hypertension in Ghent were significantly lower than those in Charleroi for individuals aged 25-44 years, while the prevalence of obesity in all subgroups in Ghent was also significantly lower. The overall predicted coronary risk in Charleroi was also significantly higher, except for men aged 45-64 years. The differences in mean predicted risk ranged from 5.0% for men aged 45-64 years to 21.2% for women aged 45-64 years. From the data in this article it seems that the trends in overall coronary risk profiles in Ghent and Charleroi are not in accordance with the observed trends in incidence of coronary heart disease (CHD) in these two cities. On the other hand, the differences in predicted coronary risk between the two cities are in the same direction as the observed differences in incidence of CHD between the two cities, but are however too small to explain fully the observed difference in incidence of CHD between the two centres.