The Influence of Socioeconomic Status on Subclinical Atherosclerosis Risk

coronary atherosclerosis
coronary atherosclerosis
Investigators evaluated the relationship between socioeconomic status and subclinical atherosclerosis and the possible relevant mechanisms.

Lower education levels may increase cardiovascular (CV) risk by accelerating early-stage atherosclerosis development, with higher tobacco consumption appearing to be the main mediator in this association, according to study results published in the Journal of the American College of Cardiology.

The current study was designed to investigate the association between socioeconomic status and subclinical atherosclerosis, as well as the potential mechanisms involved. The Progression of Early Subclinical Atherosclerosis study included 4025 participants without known CV disease (ages 40-54 years; 62.6% men) who were prospectively enrolled in the study and were assessed for socioeconomic status, traditional risk factors, lifestyle habits (physical activity, smoking, dietary patterns, and hours of sleep), and extent of subclinical atherosclerosis.

The participants were all asymptomatic employees of Santander Bank Headquarters in Madrid, Spain, and were assessed at baseline, with follow-up 3 years later. After investigators identified factors associated with atherosclerosis, the effect of socioeconomic status on subclinical atherosclerosis, as explained by lifestyle habits, was quantified using a multiple mediation model.

Although level of education was significantly associated with atherosclerosis, no differences were found in this population according to income level; however, a higher risk for generalized atherosclerosis was seen in participants with lower education compared with participants with higher education (adjusted odds ratio 1.46; 95% CI, 1.15-1.85; P =.002).

Lifestyle habits that were associated with both level of education and extent of atherosclerosis were dietary pattern, smoking status, and number of cigarettes per day, explaining 70.5% socioeconomic status’s effect on atherosclerosis.

Most of the explained between-group differences were accounted for by tobacco habit and number of cigarettes per day (34.9% smoking status and 32.1% number of cigarettes per day; P <.001). In the multiple mediation model, dietary pattern did not persist as a significant mediator (P =.2).

The study was limited because it featured a relatively homogenous cohort, which may have reduced differences in dietary patterns.

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Study investigators concluded, “Lower education level may increase CV risk by accelerating the development of atherosclerosis in its earlier stage. As tobacco consumption seems to be the main mediator in this association, smoking prevention campaigns should be considered a key preventative strategy, particularly in populations with a lower education level.”

Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Redondo-Bravo L, Fernández-Alvira JM, Górriz J, et al. Does socioeconomic status influence the risk of subclinical atherosclerosis?: a mediation model. 2019;74(4):526-553.