Socio-economic status, cardiovascular risk factors, and coronary atherosclerosis: a SCOT-HEART trial analysis

Aims To investigate the relationship between socio-economic status, plaque burden on coronary computed tomography angiography (CCTA), management, and outcomes.Methods and results In a post-hoc analysis of a multi-centre randomized control trial, we assessed associations between socio-economic status and qualitative (stenosis and adverse plaque characteristics) and quantitative (total plaque, calcified plaque, non-calcified, and low attenuation) CCTA plaque features and examined the interaction of socio-economic status on cardiovascular outcomes. Socio-economic status was available in 3948 participants of whom 1989 were randomized to CCTA and 1629 scans were suitable and available for quantitative plaque analysis. Within these 1629 participants, 15% were from the lowest socio-economic quintile and 25% from the highest socio-economic quintile. Participants in the most deprived socio-economic group were younger, had lower cardiovascular risk, and were less likely to have severe stenosis or multi-vessel disease. After adjustment for cardiovascular risk factors, there was no difference in quantitative plaque burden between socio-economic groups. After a median of 4.75 years of follow-up, CCTA-guided management was associated with similar changes in medical therapy, similar reductions in the risk of coronary heart disease death, or non-fatal myocardial infarction in low and high socio-economic groups, with no difference between the base and interaction models (P = 0.35).Conclusion Socio-economic status is not an independent predictor of coronary artery disease severity; rather, the association is mostly determined by modifiable risk factors. Preventive therapies, guided by CCTA, achieve similar benefits in both low and high socio-economic status individuals. This study looked at how a person's social and economic background (socio-economic status) is connected to heart health, how their heart disease is managed, and the outcomes. Researchers used a type of heart scan called coronary computed tomography angiography (CCTA) to measure plaque in the arteries that supply the heart, which can lead to future heart problems like heart attacks.They studied data from nearly 4000 people who participated in a large health study. Out of these, about 1600 had detailed scans that could be used for analysis. Around 15% of these people were from the poorest group, while 25% were from the richest group.Key findingsPeople from poorer backgrounds were younger, had lower overall heart disease risk, and were less likely to have severe artery blockages.After adjusting for other factors, the total amount of plaque in the arteries was about the same across all socio-economic groups.Over nearly 5 years, the treatment and outcomes (like reduced risk of heart attacks or heart disease-related deaths) were similar for both poorer and wealthier groups.However, fewer people from the poorest backgrounds participated in the study, which could affect how well the results apply to them.In short, differences in plaque between the richest and poorest was mostly explained by differences in risk factors. Both the richest and poorest gained benefit from an approach using CCTA compared with the usual care arm of the study. While heart health and outcomes were similar across different economic groups when considering treatment, more representation of poorer individuals in future research is needed.