Birth weight is inversely associated with coronary heart disease in post-menopausal women: findings from the British women's heart and health study

OBJECTIVES: (1) To assess the association between birth weight and coronary heart disease (CHD) risk in a cohort of post-menopausal women, (2) to determine the combined effects of birth weight and adult body mass index on CHD, (3) to assess the role of insulin resistance as a mediating factor in the associations. DESIGN: Cross sectional survey. SETTING: 23 British towns. PARTICIPANTS: 1394 women aged 60-79 years. MAIN OUTCOME MEASURES: coronary heart disease (n = 199 cases). RESULTS: Birth weight was inversely associated with CHD: age and survivor status of participant's mother adjusted odds ratio (95% confidence intervals) per 1 standard deviation (0.80 kg) increase in birth weight was 0.84 (0.72 to 0.97). This association strengthened to 0.80 (0.68 to 0.93) with further adjustment for adult body mass index, but there was no evidence of an interaction between birth weight and adult body mass index (p = 0.61). The association was not confounded by childhood or adulthood socioeconomic position or by adult smoking status of the participant. Adjustment for components of the insulin resistance syndrome attenuated the association to 0.87 (0.72 to 1.03). CONCLUSIONS: Intrauterine exposures that affect fetal growth also affect future adult CHD risk. The inverse association between birth weight and CHD may in part be mediated via insulin resistance.     

Life-course socioeconomic position, area deprivation, and coronary heart disease: findings from the British Women's Heart and Health Study

OBJECTIVES: We sought to determine whether residential area deprivation, over and above the effect of life-course socioeconomic status or position (SEP), is associated with coronary heart disease. METHODS: We conducted a cross-sectional analysis of 4286 women aged 60 to 79 years from 457 British electoral wards. RESULTS: After adjustment for age and 10 indicators of individual life-course SEP, the odds of coronary heart disease was 27% greater among those living in wards with a deprivation score above the median compared with those living in a ward with a deprivation score equal to or below the median (odds ratio=1.27; 95% confidence interval=1.02, 1.57). CONCLUSIONS: Adverse area-level socioeconomic characteristics, over and above individual life-course SEP, are associated with increased coronary heart disease.     

Association between childhood socioeconomic status and coronary heart disease risk among postmenopausal women: findings from the British Women's Heart and Health Study

OBJECTIVES: We assessed the association between childhood socioeconomic status (SES) and coronary heart disease among postmenopausal women. METHODS: We conducted a cross-sectional analysis of 3444 women aged 60 to 79 years. RESULTS: There was an independent linear association between childhood and adult SES and coronary heart disease. The association between childhood SES and coronary heart disease was attenuated when we adjusted for insulin resistance syndrome, adult smoking, physical activity, biomarkers of childhood nutrition, and passive smoking. CONCLUSIONS: The association between adverse childhood SES and coronary heart disease is in part mediated through insulin resistance, which may be influenced by poor childhood nutrition, and in part through the association between childhood SES and adult behavioral risk factors.     

Adult socioeconomic position and the association between height and coronary heart disease mortality: findings from 33 years of follow-up in the Whitehall Study

In the Whitehall Study, which followed 17,139 male civil servants over 33 years, the association between tall stature and coronary heart disease (CHD) mortality differed between employment grades. In men without CHD at study entry, the hazard ratio per 15-cm increase in height was 0.77 (95% confidence interval [CI]=0.69, 0.85; P<0.001) for the highest grades, but 0.84 (95% CI=0.69, 1.03; P=.10) for middle and 0.95 (95% CI=0.75, 1.20; P=.65) for low grades, suggesting that childhood and adult social conditions may interact in their influence on coronary risk.     

Longitudinal study of risk factors for coronary heart disease across the menopausal transition

The patterns of change in blood lipids, diastolic blood pressure, body mass index, smoking and drinking behaviors, and exercise were examined in an ongoing longitudinal study from 1991 to 1995 of 150 middle-aged Melbourne, Australia, women as they passed through menopause. Changes in risk factors over time were examined with reference to time of the final menstrual period (FMP). Random effects models were fitted with adjustments for repeated measures and other covariates, including age. There were overall net increases between 3 years before and the 3 years after menopause of 0.25 mmol/liter for low density lipoprotein cholesterol, 0.05 mmol/liter for high density lipoprotein cholesterol (HDL cholesterol), 0.34 mmol/liter for triglycerides, 0.12 kg/m2 for body mass index, and 0.48 mmHg for diastolic pressure. The proportion of drinkers decreased by 13%, that of smokers increased by 17%, and that of women who exercised at least once a week increased by 6%. The only change dependent on the FMP was a significant decrease in HDL cholesterol (counterbalanced by a similar rise in HDL cholesterol in the year before the FMP), and the rate of decrease was maximal around 9 months after menses ceased, with an instantaneous estimate of slope of 0.55 mmol/liter per year.     

Psychosocial factors of coronary heart disease and quality of life among Roma coronary patients: a study matched by socioeconomic position

Objectives  

The aim of this study was to assess whether psychosocial factors and health-related quality of life (HRQL) differ between Roma and non-Roma coronary patients and to what degree socioeconomic status (SES) explains these differences.     

Women, work and coronary heart disease: prospective findings from the Framingham heart study.

This study examined the relationship of employment status and employment-related behaviors to the incidence of coronary heart disease (CHD) in women. Between 1965 and 1967, a psychosocial questionnaire was administered to 350 housewives, 387 working women (women who had been employed outside the home over one-half their adult years), and 580 men participating in the Framingham Heart Study. The respondents were 45 to 64 years of age and were followed for the development of CHD over the ensuing eight years. Regardless of employment status, women reported significantly more symptoms of emotional distress than men. Working women and men were more likely to report Type A behavior, ambitiousness, and marital disagreements than were housewives; working women experienced more job mobility than men, and more daily stress and marital dissatisfaction than housewives or men. Working women did not have significantly higher incidence rates of CHD than housewives (7.8 vs 5.4 per cent, respectively). However, CHD rates were almost twice as great among women holding clerical jobs (10.6 per cent) as compared to housewives. The most significant predictors of CHD among clerical workers were: suppressed hostility, having a nonsupportive boss, and decreased job mobility. CHD rates were higher among working women who had ever married, especially among those who had raised three or more children. Among working women, clerical workers who had children and were married to blue collar workers were a highest risk of developing CHD (21.3 per cent).     

Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study

Quantifying the impact of different modifiable behavioral and biological risk factors on socioeconomic disparities in coronary heart disease (CHD) may help inform targeted, population-specific strategies to reduce the unequal distribution of the disease. Previous studies have used analytic approaches that limit our ability to disentangle the relative contributions of these risk factors to CHD disparities. The goal of this study was to assess mediation of the effect of low education on incident CHD by multiple risk factors simultaneously. Analyses are based on 15,067 participants of the Dutch Monitoring Project on Risk Factors for Chronic Diseases aged 20–65 years examined 1994–1997 and followed for events until January 1, 2008. Path analysis was used to quantify and test mediation of the low education-CHD association by behavioral (current cigarette smoking, heavy alcohol use, poor diet, and physical inactivity) and biological (obesity, hypertension, diabetes, and hypercholesterolemia) risk factors. Behavioral and biological risk factors accounted for 56.6 % (95 % CI 42.6–70.8 %) of the low education-incident CHD association. Smoking was the strongest mediator, accounting for 27.3 % (95 % CI 17.7–37.4 %) of the association, followed by obesity (10.2 %; 95 % CI 4.5–16.1 %), physical inactivity (6.3 %; 95 % CI 2.7–10.0 %), and hypertension (5.3 %; 95 % CI: 2.8–8.0 %). In summary, in a Dutch cohort, the majority of the relationship between low education and incident CHD was mediated by traditional behavioral and biological risk factors. Addressing barriers to smoking cessation, blood pressure and weight management, and physical activity may be the most effective approaches to eliminating socioeconomic inequalities in CHD.     

Indices of socioeconomic position across the life course as predictors of coronary calcification in black and white men and women: coronary artery risk development in young adults study

Few studies have investigated the association of socioeconomic status (SES) and coronary artery calcification (CAC) and only one study has examined African Americans separately from Caucasians, despite empirical evidence suggesting that blacks have equivalent or lower CAC, relative to whites. We tested the hypotheses that lower childhood SES and lower average education, occupation, and income and change in SES (slope) in adulthood are related to risk of CAC in blacks and whites in the US CARDIA study. Parental education and occupation were measured at study entry (Year 0 in 1985-1986) and participant education, occupation, and household income were evaluated multiple times throughout a 20 year follow-up period at four sites in the United States. CAC was measured at Year 20 in 3138 (45% black) participants in CARDIA; 19% had CAC. Latent growth models and multivariate logistic regression analyses adjusted for the major risk factors for CAC. Multivariate models showed that lower paternal education in blacks and lower maternal occupational status in the full sample and in whites were related to higher risk of any CAC, independent of adult SES. Lower average adult education, occupation, and income were related to higher risk of any CAC, with the effects primarily in blacks. Our results are the first to show that SES, measured retrospectively and prospectively in multiple ways, is related to CAC, and the first to document the effects primarily in blacks.     

Associations between socioeconomic position and asthma: findings from a historical cohort

Understanding the association between asthma and socioeconomic position (SEP) is key to identify preventable exposures to prevent inequalities and lessen overall disease burden. We aim to assess the variation in asthma across SEP groups in a historical cohort before the rise in asthma prevalence. Male students participating in a health survey at Glasgow University from 1948 to 1968 (n?=?11,274) completed medical history of bronchitis, asthma, hay fever, eczema/urticaria, and reported father's occupation. A subsample responded to postal follow-up in adulthood (n?=?4,101) that collected data on respiratory diseases, early life and adult SEP. Lower father's occupational class was associated with higher odds of asthma only (asthma without eczema/urticaria or hay fever) (trend adjusted multinomial odds ratio (aMOR)?=?1.23, 95?% CI 1.03-1.47) but with lower odds of asthma with atopy (asthma with eczema/urticaria or hay fever) (trend aMOR?=?0.66, 95?% CI 0.52-0.83) and atopy alone (trend aMOR?=?0.84, 95?% CI 0.75-0.93). Household amenities (<3), in early life was associated with higher odds of adult-onset asthma (onset?>?30?years) (OR?=?1.48, 95?% CI 1.07-2.05) though this association attenuated after adjusting for age. Adult SEP (household crowding, occupation, income and car ownership) was not associated with adult-onset asthma. Lower father's occupational class in early life was associated with higher odds of asthma alone but lower odds of asthma with atopy in a cohort that preceded the 1960s rise in asthma prevalence. Different environmental exposures and/or disease awareness may explain this opposed socioeconomic patterning, but it is important to highlight that such patterning was already present before rises in the prevalence of asthma and atopy.     

An additional dimension to health inequalities: disease severity and socioeconomic position

OBJECTIVE: To investigate the association between the severity of hip pain and disability, and a number of measures of socioeconomic position, using a range of individual and ecological socioeconomic indicators. DESIGN: Interviewer administered and self completed questionnaires on symptoms of pain and disability, general health and socioeconomic indicators, completed by people reporting hip pain in a cross sectional, postal, screening questionnaire. SETTING: 40 general practices from inner city, suburban and rural areas of south west England. PARTICIPANTS: 954 study participants who had reported hip pain in a postal questionnaire survey of 26,046 people aged 35 and over, selected using an age/sex stratified random probability sample. DATA: Individual indicators of socioeconomic position: social class based on occupation, maximum educational attainment, car ownership, gross household income, manual or non-manual occupation and living alone. Area level measures of socioeconomic position: Townsend scores for material deprivation at enumeration district level; urban or rural location based on the postcode of residence. Severity of hip disease, measured by the pain, disability and independence components of the New Zealand score for major joint replacement. Self reported comorbidity validated using general practice case notes and summary measures of general health. MAIN RESULTS: Increasing disease severity was strongly associated with increasing age and a variety of measures of general health, including comorbidity. The data provide considerable evidence for the systematic association of increased severity of hip disease with decreasing socioeconomic position. Measures of socioeconomic position that were systematically associated with increasing disease severity, standardised for age and sex, included educational attainment (relative index of inequality 1.95 (95% confidence intervals 1.29 to 2.62) and income (relative index of inequality 4.03 (95% confidence intervals 3.43 to 4.64). Those with access to a car (mean disease severity 15.5) had statistically significant lower severity of hip disease than those without (mean 17.5, p < 0.01). Similar results were found for access to higher or further education and living with others. For a given level of income, people with greater comorbidity had more severe hip pain and disability. The gradient in disease severity between rich and poor was steepest among those with the most comorbidity. CONCLUSIONS: People with lower socioeconomic position experience a greater severity of hip disease. The poorest sector of the population seem to be in double jeopardy: they not only experience a greater burden of chronic morbidity but also a greater severity of hip disease. This study has implications for health care provision, if the National Health Service is to live up to its principle of equal treatment for equal medical need.     

Association of childhood intelligence with risk of coronary heart disease and stroke: findings from the Aberdeen Children of the 1950s cohort study

Objectives Associations of cognitive function assessed in adulthood with coronary heart disease (CHD) and stroke might reflect a causal effect or could be explained by residual confounding or a common underlying pathology (atherosclerosis) that links both declines in cognitive function and increased risk of cardiovascular disease (i.e. reverse causality). Our objective was to examine the association of childhood intelligence (assessed at an age when generalised atherosclerosis would be extremely unlikely) with risk of CHD and stroke in later life in a cohort of females and males on whom information on a wide range of potential confounding factors is available. Methods Cohort study of 11,125 individuals born in Aberdeen, Scotland, between 1950 and 1956, who had childhood intelligence measured at ages 7, 9, 11 and who have been followed up by linkage to hospital admissions and mortality data. Results The cohort contributed 264,672 person years of follow-up and over this time 93 females experienced CHD and 56 experienced a stroke; 264 males experienced CHD and 67 a stroke. There were inverse associations of childhood intelligence measured at all 3 ages (7, 9, 11 years) with both CHD and stroke, with some evidence that the association with intelligence assessed at age 11 was stronger than at younger ages. The magnitude of associations were similar for CHD and stroke. Adjustment for a range of potential confounding factors did not markedly attenuate the associations and there was evidence that the association was stronger in females than in males. For example, the age adjusted hazard ratio of a combined outcome of CHD and stroke per 1 standard deviation (SD; 1SD = 15 points) difference in intelligence score at age 11 in females was 0.52 (95% CI: 0.42, 0.64) and in males was 0.78 (95% CI: 0.68, 0.90), with adjustment for all potential confounding factors these became 0.60 (95% CI: 0.48, 0.76) and 0.84 (95% CI: 0.72, 0.98) respectively; P-value for interaction with gender in both models =0.002. Adjustment for educational attainment attenuated both associations to the null and removed evidence of a gender difference. Conclusions Our results suggest an association of intelligence in childhood with future CHD and stroke that is unlikely to be explained by reverse causality and was robust to adjustment for a wide range of confounding factors. This association appeared to be mediated by educational attainment. The gender difference seen in our study requires replication in other studies. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Earthquake and coronary heart disease risk factors: a longitudinal study.

The longitudinal association between a number of coronary heart disease risk factors and the experience of a natural disaster (earthquake) was analyzed in a group of workers participating in a longitudinal epidemiologic investigation. The 5-year follow-up examination was interrupted by a major earthquake, and examinations were resumed 2 weeks after the quake. Participants screened after the quake had, on average, higher heart rates, serum cholesterol, and triglycerides than participants examined before the quake; these differences were independent from the coronary heart disease risk factor values measured 5 years previously during the baseline examination. The data collected during the 12-year examination indicated that the observed short-term increase in serum lipids and heart rate was not present long-term (7 years after the quake). These longitudinal data indicate that exposure to a natural disaster can be associated with short-term increases in heart rate, serum cholesterol, and triglycerides but that there is no apparent long-term effect on these coronary heart disease risk factors.