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Impact of socioeconomic status on coronary artery calcification

Journal article
Authors D. Djekic
Oskar Angerås
Georg Lappas
Erika Fagman
Björn Fagerberg
Göran Bergström
Annika Rosengren
Published in European Journal of Preventive Cardiology
Volume 25
Issue 16
Pages 1756-1764
ISSN 2047-4873
Publication year 2018
Published at Institute of Medicine
Institute of Clinical Sciences, Department of Radiology
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1756-1764
Language en
Links dx.doi.org/10.1177/2047487318792103
Keywords Socioeconomic status, social classes, neighbourhood, coronary artery calcification, subclinical, risk-factors, atherosclerosis mesa, deprivation, disease, score
Subject categories Community medicine, Cardiovascular medicine

Abstract

Background Low socioeconomic status is associated with an increased risk of coronary artery disease, but few studies have investigated the potential link between living in an area with a low versus a high socioeconomic status and coronary artery calcification, a marker of subclinical coronary artery disease. Design The design of this study was a cross-sectional study. Methods We evaluated 1067 participants with no history of coronary artery disease from the pilot phase of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Men and women aged 50-64 years were recruited from three high-socioeconomic status (n = 541) and three low-socioeconomic status (n = 526) areas in the city of Gothenburg (550,000 inhabitants). The coronary artery calcification score was assessed with the Agatston method using computed tomography, with individuals classified into either no coronary calcification (n = 625; mean age, 57 years) or any coronary artery calcification (n = 442; mean age, 59 years (men, 68.5%)). Results Coronary artery calcification was present in 244 (46.3%) and 198 (36.6%) individuals from the low- and high-socioeconomic status areas, respectively. Participants from the low-socioeconomic status areas had a significantly higher risk factor burden. In a multivariable logistic regression model with adjustment for age, sex and cardiovascular risk factors, the odds for coronary artery calcification were not significantly higher among persons living in low-socioeconomic status areas (odds ratio = 1.18, 95% confidence interval = 0.87-1.60). Conclusion In this relatively small cross-sectional study, we observed an association between living in a low-socioeconomic status area and coronary artery calcification. However, this was mostly explained by higher levels of cardiovascular disease risk factors, indicating that the effect of socioeconomic status on the atherosclerotic process works through an increased burden of cardiovascular disease risk factors.

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