Defining the Path Between Social and Economic Factors, Clinical and Lifestyle Determinants, and Cardiovascular Disease

Background: Low socioeconomic status is associated with poorer cardiovascular health. Objectives: The aim of the present work was to evaluate how social and economic factors influence modifiable cardiovascular disease risk factors and thus, acute coronary syndrome or ischemic stroke presence. Methods: One thousand participants were enrolled; 250 consecutive patients with a first acute coronary syndrome (83% were male, 60 +/- 12 years old) and 250 control subjects, as well as 250 consecutive patients with a first ischemic stroke (56% were male, 77 +/- 9 years old) and 250 control subjects. The control subjects were population-based and age-sex matched with the patients. Detailed information regarding their medical records, lifestyle characteristics, education level, financial status satisfaction, and type of occupation were recorded. Results: After controlling for potential confounding factors, significant inverse associations were observed regarding financial status satisfaction and sedentary/mental type occupation with acute coronary syndrome or stroke presence, but not with the educational level. Nevertheless, further evaluation using path analysis, revealed quite different results, indicating that the education level influenced the type of occupation and financial satisfaction, hence affecting indirectly the likelihood of developing a cardiovascular disease event. Conclusions: Social and economic parameters interact with modifiable cardiovascular disease risk factors through multiple pathways.