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Socioeconomic status predicts second cardiovascular event in 29,226 survivors of a first myocardial infarction
Karolinska Inst, Funct Area Emergency Med Solna, Karolinska Univ Hosp, S-17176 Stockholm, Sweden;Karolinska Inst, Dept Med Solna, S-17176 Stockholm, Sweden.
Karolinska Inst, Funct Area Emergency Med Solna, Karolinska Univ Hosp, S-17176 Stockholm, Sweden;Karolinska Inst, Dept Med Solna, S-17176 Stockholm, Sweden.
Karolinska Inst, Unit Biostat, Inst Environm Med, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.ORCID iD: 0000-0003-2247-8454
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2018 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, no 9, p. 985-993Article in journal (Refereed) Published
Abstract [en]

Background Risk assessment post-myocardial infarction needs improvement, and risk factors derived from general populations apply differently in secondary prevention. The prediction of subsequent cardiovascular events post-myocardial infarction by socioeconomic status has previously been poorly studied. Design Swedish nationwide cohort study. Methods A total of 29,226 men and women (27%), 40-76 years of age, registered at the standardised one year revisit after a first myocardial infarction in the secondary prevention quality registry of SWEDEHEART 2006-2014. Personal-level data on socioeconomic status measured by disposable income and educational level, marital status, and the primary endpoint, first recurrent event of atherosclerotic cardiovascular disease, defined as non-fatal myocardial infarction or coronary heart disease death or fatal or non-fatal stroke were obtained from linked national registries. Results During the mean 4.1-year follow-up, 2284 (7.8%) first recurrent manifestations of atherosclerotic cardiovascular disease occurred. Both socioeconomic status indicators and marital status were associated with the primary endpoint in multivariable Cox regression models. In a comprehensively adjusted model, including secondary preventive treatment, the hazard ratio for the highest versus lowest quintile of disposable income was 0.73 (95% confidence interval 0.62-0.83). The association between disposable income and first recurrent manifestation of atherosclerotic cardiovascular disease was stronger in men as was the risk associated with being unmarried (tests for interaction P<0.05). Conclusions Among one year survivors of a first myocardial infarction, first recurrent manifestation of atherosclerotic cardiovascular disease was predicted by disposable income, level of education and marital status. The association between disposable income and first recurrent manifestation of atherosclerotic cardiovascular disease was independent of secondary preventive treatment but further study on causal pathways is needed.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD , 2018. Vol. 25, no 9, p. 985-993
Keywords [en]
Social class, secondary prevention, cardiovascular disease, myocardial infarction, stroke
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-358072DOI: 10.1177/2047487318766646ISI: 000434701900021PubMedID: 29664673OAI: oai:DiVA.org:uu-358072DiVA, id: diva2:1243284
Funder
Swedish Heart Lung FoundationSwedish Association of Local Authorities and RegionsAvailable from: 2018-08-30 Created: 2018-08-30 Last updated: 2018-08-30Bibliographically approved

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