Socio-economic position and cardiovascular risk factors in an Italian rural population

Cardiovascular Risk Factors in Iranian Adults according to Educational Levels: Isfahan Healthy Heart Program

There is abundant evidence that the socioeconomic status (SES) is inversely associated with CVD risk factors. The objective of this study is to describe the distribution of CVD risk factors according to educational level in Iranian adults. A cross-sectional survey was performed on subjects over the age of 19 in three cities. Demographic data, as well as information on educational level and smoking habits was obtained and then height, weight and blood pressure measurement and blood sampling were arranged. Data was analyzed by the Mantel-Haenszel, Kendalls T correlation and multivariate analysis test. Of 9587 subjects, 48% were men and 52% were women, with mean ages of 39.0±15.3 and 38.8±14.5 years, respectively. All CVD risk factors showed an inverse relationship with educational level in all subjects, except for smoking and low HDL-C in women. High TC and LDL-C and low HDL-C were inversely related to educational level (P<0.05); however, this relationship was not significant with Mantel-Haenszel test in men. The association between CVD risk factors and educational level in women was stronger than in men. The differences found between CVD risk factors with educational level are important and should be considered in programs designed to increase level of education in order to lower CVD risk factors. Asia Pac J Public Health 2005: 17(1): 9-14.

Improving long-term prediction of first cardiovascular event: the contribution of family history of coronary heart disease and social status

OBJECTIVE

The aim of this study is to assess whether family history of coronary heart disease (CHD) and education as proxy of social status improve long-term cardiovascular disease risk prediction in a low-incidence European population.

METHODS

The 20-year risk of first coronary or ischemic stroke events was estimated using sex-specific Cox models in 3956 participants of three population-based surveys in northern Italy, aged 35-69 years and free of cardiovascular disease at enrollment. The additional contribution of education and positive family history of CHD was defined as change in discrimination and Net Reclassification Improvement (NRI) over the model including 7 traditional risk factors.

RESULTS

Kaplan-Meier 20-year risk was 16.8% in men (254 events) and 6.4% in women (102 events). Low education (hazard ratio=1.35, 95%CI 0.98-1.85) and family history of CHD (1.55; 1.19-2.03) were associated with the endpoint in men, but not in women. In men, the addition of education and family history significantly improved discrimination by 1%; NRI was 6% (95%CI: 0.2%-15.2%), raising to 20% (0.5%-44%) in those at intermediate risk. NRI in women at intermediate risk was 7%.

CONCLUSION

In low-incidence populations, family history of CHD and education, easily assessed in clinical practice, should be included in long-term cardiovascular disease risk scores, at least in men.

Differences in Predicted Cardiovascular Risk in Sinhalese and Tamils in Sri Lanka Compared With Sri Lankans in Norway

Using data from 3 cross-sectional studies, the authors compared the estimated risk of cardiovascular diseases between migrant Sri Lankans in Oslo, Norway, and Tamils and Sinhalese in Kandy, Sri Lanka. The authors found that Sri Lankans in Oslo had significantly lower Framingham coronary heart disease (CHD) risk. Among men, the prevalence with estimated 10-year risk of a CHD event ≥10% was 20.6% in Oslo, 31.1% in Kandy Tamils, and 44.2% in Kandy Sinhalese. The corresponding figures in women were 10.4% in Oslo, 19.2% in Tamils, and 14.9% in Sinhalese. Risk of fatal cardiovascular disease estimated by the SCORE model showed a similar pattern. The Oslo group had a higher body mass index (BMI), but the differences were observed in all BMI categories. In conclusion, despite a lower BMI, Tamils and Sinhalese in Sri Lanka had higher estimated cardiovascular risk compared with Sri Lankans in Norway, mainly because of poorer lipid profiles.

Socio-economic status and prevention of cardiovascular disease in Italy: evidence from a national health survey

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death and disability in the world. Many cardiovascular risk factors can be prevented. We assessed whether socio-economic factors are associated with individual preventive behaviours in Italy.

METHODS

A cross-sectional analysis of a nationally representative sample of 47,391 adults aged 40-69 years was undertaken using 2004-05 National Health Interview Survey data. Logistic regression models were developed to assess the association between socio-economic status (SES) and regular monitoring of blood pressure, cholesterol, body mass index and glycaemia. SES was estimated according to education and occupation.

RESULTS

SES was significantly associated with regular monitoring of risk factors for CVD. The most educated were more likely to monitor cholesterol levels than those with less education [men odds ratio (OR) 1.64, 95% confidence interval (CI) 1.46-1.86; women OR 1.36, 95% CI 1.19-1.55]. Individuals in the highest occupational class controlled weight more frequently than those disadvantaged with an OR of 1.24 (95% CI 1.04-1.49) for men and an OR of 1.26 (95% CI 1.12-1.42) for women.

CONCLUSION

Socio-economic disparities in the prevention of risk factors for CVD were clearly observed among Italian adults, generally favouring higher socio-economic groups.

Cognitive Impairment and Carotid Atherosclerosis in a General Italian Midlife and Old Population

The authors describe the design and the general, ultrasonographic, neuropsychological methodology of an observational epidemiological population survey, named REMEMBER (Registry Evaluation Memory in Buttrio e Remanzacco) conducted in the northeast of Italy in a randomized stratified sample of 1,026 subjects (554 F and 472 M) aged 55-98 years. The study was planned as cross-sectional and longitudinal survey of cognitive impairment, cardiovascular risk factors, carotid atherosclerosis in a midlife and older Italian population sample. The objectives of the first phase are to assess the prevalence of the different types of dementia, the cognitive impairment non-dementia, the cardiovascular risk factors, the carotid intima-media thickness and arterial distensibility, and of depression. The conclusions of this study will make it possible to organize preventive and interventional strategies for these epidemic conditions.

Socio-economic-position overall and cause-specific mortality in an Italian rural population

STUDY OBJECTIVE

To investigate the association between socio-economic position, overall and cause-specific mortality, and risk factors in a sample of men and women in the Italian population.

DESIGN

Cohort study. MATISS Project (Malattie Aterosclerotiche Istituto Superiore di Sanità).

SETTING

Rural area, Province of Latina, Lazio, central Italy.

PARTICIPANTS

Baseline data were obtained for 8512 subjects (3982 men and 4530 women), 20-75 years of age, of whom 713 died during 11 (range 2; 15) years of follow-up. Education and occupation (used as measures of socio-economic position), smoking history, alcohol consumption, health status measures, blood pressure, plasma lipids and ECGs were collected at baseline. Linear and logistic regressions were performed to examine the association between socioeconomic position and risk factors. The hazard ratios (HRs) of all-cause, CVD and cancer mortality, according to educational level and occupational categories were computed using Cox proportional hazard models.

MAIN RESULTS

The lower social groups had a more adverse risk factors profile with the exception of smoking habit in women and HDL cholesterol in men. The risk of death in college educated men was 50% of that found for men with no formal education. The risk of cancer in the least educated was 60% higher than for highly educated men. No clear pattern was observed in women. The HRs were not substantially changed when controlling for potential confounding factors. In both men and women mortality did not vary by occupational class.

CONCLUSIONS

The association observed between education and mortality was stronger than previously reported in Italy. This may reflect changes in risk factors profile; in particular with regard to smoking habit. The effect of changes in risk factor distribution will become apparent in future mortality and morbidity patterns.

Educational Level and Stroke Mortality

BACKGROUND AND PURPOSE

Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by educational level among men and women aged >or=30 years in 10 European populations during the 1990s.

METHODS

Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between educational level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on educational differences in life expectancy.

RESULTS

Differences in stroke mortality according to educational level were of a similar magnitude in most populations. However, larger educational differences were observed in Austria. Overall, educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce educational differences in life expectancy by 7% among men and 14% among women.

CONCLUSIONS

Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to educational differences in stroke mortality across Europe.

Citizens and family doctors facing awareness and management of traditional cardiovascular risk factors: results from the Global Cardiovascular Risk Reduction Project (Help Your Heart Stay Young Study)

BACKGROUND AND AIM

The numerous guidelines and multiple approaches to managing cardiovascular risk factors have reduced the number of fatal events but not the incidence of cardiovascular disease (CVD). One rarely explored aspect is the extent to which individuals perceive their own risk in relation to their education and history of CVD. Furthermore, Italy has a State-based Health System, in which family doctors (FDs) may be an extremely useful and relatively low cost resource for risk management, but the degree of their involvement in individual CVD risk management has not been previously assessed.

METHODS AND RESULTS

The Department of Clinical and Experimental Medicine of Federico II University, Naples, Italy, and the Neapolitan Section of the Italian Society of Family Doctors (SIMG), developed an epidemiological survey to evaluate the level and awareness of CVD risk in subjects in the urban area of Naples, and the degree of involvement of FDs in CVD risk management. During a period of a few months, the subjects who visited their FDs were invited to respond to a standard self-explanatory questionnaire, and the FDs were required to provide quantitative information concerning the CVD risk factors of each enrolled subject from their databases in order to assess global CVD risk. The data included cholesterol and blood pressure (BP) levels, and had to be collected within six months of the visit; if the date were missing, the fact was recorded. The present analysis was based on data concerning the 5,687 subjects who had entered the study by January 2002, 7.6% of whom reported CVD (myocardial infarction (MI), stroke, angina, cerebral transient ischemic attack: CD+) and 92.4% did not (CVD-). MI was the most frequent CVD, and 18% of the CVD+ cases reported more than one non-fatal cardiovascular event. On average, the CVD+ subjects were older and more often men. After adjusting for age and FD, they also had a higher body mass index (BMI) and prevalence of obesity, higher self-reported BP, a lower education level, and more often referred high cholesterol levels, hypertension and diabetes. On the contrary, the proportion of smokers was higher in the CVD- group. Among the subjects who declared that they did not have a high cholesterol level, 11% reported recent values of > 200 mg/dL. The FDs of 36% of the cases were unable to assess the individual global CV risk level using quantitative data from their electronic databases. The most frequently missing information was the level of total cholesterol. Missing data were more frequent in the CVD- than the CVD+ subjects, regardless of age and FD.

CONCLUSIONS

The results of our study suggest that the awareness of CVD risk among subjects is somewhat vague. The FDs were generally able to provide a quantitative assessment of CVD risk in their patients. CVD risk prevention programmes may be more successful if they stress knowledge and awareness in the population, and stimulate FDs to undertake more stringent quantitative assessments of CVD risk factors.