Educational level and risk profile of cardiac patients in the EUROASPIRE II substudy

Abstract

Study objective: To ascertain, whether, conventional risk factors and readiness of coronary patients to modify their behaviour and to comply with recommended medication were associated with education in patients with established coronary heart disease. Design and methods: EUROASPIRE II was a cross sectional survey undertaken in 1999-2000 in 15 European countries to ascertain how effectively recommendations on coronary preventions are being followed in clinical practice. Consecutive patients, men and women (71 years who had been hospitalised for acute coronary syndrome or revascularisation procedures, were identified retrospectively. Data were collected through a review of medical records, interview, and examination at least six months after hospitalisation. The education reached was ascertained at the interview. Main results: A total of 5556 patients (1319 women) were evaluated. Significantly more patients with ischaemia had only primary education, in contrast with the remaining diagnostic groups. Body mass index and glucose were negatively associated with educational level, while HDL-cholesterol was positively associated. Men with highest education had significantly lower systolic blood pressure and total cholesterol. The prevalence of current smoking decreased significantly from primary to secondary and high education only in men. Both men and women with primary educational level were more often treated with antidiabetics, and antihypertensives, but less often with lipid lowering drugs. The effectiveness of treatment was virtually the same in all education groups. Conclusions: Patients with higher education had lower global coronary risk, than those with lower education. This should be considered in clinical practice. Particular strategies for risk communication and counselling are needed for those with lower education status. S ocioeconomic status (SES) is believed to be important in influencing the development of coronary heart disease (CHD). SES is a very complex phenomenon predicted by a broad range of variables, mainly combining the influences of education and occupation.1 Higher education virtually enables to reach higher SES and access to positive, social, cultural, psychological, and economic resources. Over time, education has become the most commonly used measure of SES in epidemiological studies.2-5 These studies have shown an inverse relation between education and lifestyle related risk factors, as well as long term risk of CHD, cardiovascular disease, and all cause mortality.2 6 7 It has been also shown, that among such measures of SES, as education, income and occupation, low level of education was most consistently associated with higher coronary risk.2 3 High SES has been supposed as a predictor of good health.1 The influence of education on coronary risk factors and their control after acute coronary syndromes has not yet been thoroughly studied. Diagnostic studies in patients with CHD mostly included social support, job control demands, anxiety, depression, hostility and anger, as SES measure...

Improvement of cardiovascular risk profile in an elderly population of low social level: the ICON (Improving Cardiovascular risk profile in Older Neapolitans) study

“…23 On the other hand, Italian data indicate that this problem could not be limited to family medicine or to particular areas: in a sample of hypertensive patients referred to medical specialists operating in many Italian regions, an insufficient detection of cardiovascular RFs was frequently observed. 24 Our data indicating a higher prevalence of several cardiovascular RFs at lower educational and occupational levels confirm similar results obtained previously in patients with suspected 7 or established 6 coronary heart disease, working people 25 and general population. [20][21][26][27][28] However, the data analysed in these studies were obtained across wide age ranges, or even excluding elderly persons.…”

“…Beside its role as cardiovascular risk factor (RF) per se, old age is often accompanied by social isolation and psychological derangements, which contribute to poor awareness of health problems, low compliance to treatment, impaired control of cardiovascular RFs and ultimately, increased number of cardiovascular events. [1][2][3][4] Moreover, cross-sectional [5][6] and prospective studies 7 have demonstrated that educational and socio-economic levels also exert a remarkable effect on the prevalence of cardiovascular RFs, patient awareness and compliance and clinical outcomes.…”

Statin gyógyszerszedési gyakorlat myocardialis infarctus után Magyarországon

“…Sajnos az ezetimib eredményei a nemrég megjelent IMPROVE-IT miatt még nem épülhettek be a napi rutinba, így itt a statisztika erejét rontotta az alacsony betegszám. Ugyanakkor azt is fontos megemlíteni, hogy nem elsősorban a szociális státusz az, ami meghatározza a beteg gyógy-szerszedési szokásait, gyógyszerhűségét, hanem a betegre szánt idő és meggyőzés [12,13].…”

Income and recurrent events after a coronary event in women

“…Biological risk factors for CHD, such as lipids [3,[15][16][17][18], inflammatory markers [19,20], haemostatic factors [21,22], blood pressure [23], glucose levels [16,17], heart rate [3], history of diabetes [17,18] and lower cortisol response to stress [24] have also been shown to be related to socioeconomic measures.…”

“…Compelling evidence suggests that, compared to those with a better position, individuals from lower socioeconomic groups are more likely to be obese [3,7,9,[15][16][17], smokers [3,7,9,[15][16][17][18] and heavy drinkers [3,16], to do less physical exercise [7,9,16] and to consume more atherogenic food [15].…”