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      Socioeconomic characteristics of patients with coronary heart disease in relation to their cardiovascular risk profile

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          Abstract

          Objective

          People’s socioeconomic status (SES) has a major impact on the risk of atherosclerotic cardiovascular disease (ASCVD) in primary prevention. In patients with existing ASCVD these associations are less documented. Here, we evaluate to what extent SES is still associated with patients’ risk profile in secondary prevention.

          Methods

          Based on results from a large sample of patients with coronary heart disease from the European Action on Secondary and Primary Prevention through Intervention to Reduce Events study, the relationship between SES and cardiovascular risk was examined. A SES summary score was empirically constructed from the patients’ educational level, self-perceived income, living situation and perception of loneliness.

          Results

          Analyses are based on observations in 8261 patients with coronary heart disease from 27 countries. Multivariate logistic regression analyses demonstrate that a low SES is associated (OR, 95% CI) with lifestyles such as smoking in men (1.63, 1.37 to 1.95), physical activity in men (1.51, 1.28 to 1.78) and women (1.77, 1.32 to 2.37) and obesity in men 1.28 (1.11 to 1.49) and women 1.65 (1.30 to 2.10). Patients with a low SES have more raised blood pressure in men (1.24, 1.07 to 1.43) and women (1.31, 1.03 to 1.67), used less statins and were less adherent to them. Cardiac rehabilitation programmes were less advised and attended by patients with a low SES. Access to statins in middle-income countries was suboptimal leaving about 80% of patients not reaching the low-density lipoprotein cholesterol target of <1.8 mmol/L. Patients’ socioeconomic level was also strongly associated with markers of well-being.

          Conclusion

          These results illustrate the complexity of the associations between SES, well-being and secondary prevention in patients with ASCVD. They emphasise the need for integrating innovative policies in programmes of cardiac rehabilitation and secondary prevention.

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          Most cited references4

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          Socioeconomic disparities in the management of coronary heart disease in 438 general practices in Australia.

          This population-based cross-stional and panel study investigated disparities in the management of coronary heart disease (CHD) by level of socioeconomic status.
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            Is Open Access

            Socioeconomic Factors, Secondary Prevention Medication, and Long‐Term Survival After Coronary Artery Bypass Grafting: A Population‐Based Cohort Study From the SWEDEHEART Registry

            Background Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting (CABG), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary prevention medications contributes to the inferior long‐term survival in CABG patients with a low income and short education. Methods and Results Patients who underwent CABG in Sweden between 2006 to 2015 and survived at least 6 months after discharge (n=28 448) were included in a population‐based cohort study. Individual patient data from 5 national registries, including the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) registry, covering dispensing of secondary prevention medications (statins, platelet inhibitors, β‐blockers, and RAAS inhibitors), socioeconomic factors, patient characteristics, comorbidity, and long‐term mortaity were merged. All‐cause mortality risk was estimated using multivariable Cox regression models adjusted for patient characteristics, baseline comorbidities, time‐updated secondary prevention medications, and socioeconomic status. Long‐term mortality was higher in patients with a low income and short education. Statins and platelet inhibitors were dispensed less often to patients with a low income, both at baseline and after 8 years. The decline in dispensing over time was steeper for low‐income patients. Short education was not associated with reduced dispensing of any secondary prevention medication. Use of statins (adjusted hazard ratio=0.57 [95% CI, 0.53–0.61]), RAAS inhibitors (adjusted hazard ratio=0.78 [0.73–0.84]), and platelet inhibitors (adjusted hazard ratio=0.74 [0.68–0.80]) were associated with reduced long‐term mortality irrespective of socioeconomic status. Conclusions Secondary prevention medications are dispensed less often after CABG to patients with low income. Underusage of secondary prevention medications after CABG is associated with increased mortality risk independently of income and extent of education.
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              Association between income and control of cardiovascular risk factors after acute coronary syndromes: an observational study

              Jaquet (2019)
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                Author and article information

                Contributors
                (View ORCID Profile)
                (View ORCID Profile)
                Journal
                Heart
                Heart
                BMJ
                1355-6037
                1468-201X
                October 16 2020
                : heartjnl-2020-317549
                Article
                10.1136/heartjnl-2020-317549
                33067329
                2d8dad99-30c9-4134-a3f8-d4b7547df71e
                © 2020
                History

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