Impact of socioeconomic status on incident heart failure and left ventricular dysfunction: systematic review and meta-analysis

Potter, Elizabeth; Hopper, Ingrid; Sen, Jonathan; Salim, Agus; Marwick, Thomas H.

doi:10.1093/ehjqcco/qcy047

Cited by 52 publications

(42 citation statements)

References 43 publications

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“…Our findings are broadly in line with a vast body of observational studies showing a protective association of high educational level on major depressive disorder 42 , amyotrophic lateral sclerosis 45 , Alzheimer’s disease 46 , coronary heart disease 47 , heart failure 48 , stroke 49 , lung cancer 52 , type 2 diabetes 53 , chronic kidney disease 54 , hypertension 56 and obesity 55 . However, for suicide attempts, posttraumatic stress disorder, breast cancer and prostate cancer, our MR findings differ from observational findings.…”

Section: Discussionsupporting

confidence: 89%

“…A systematic literature search was conducted in the PubMed database before November 1 st , 2019 to find meta-analyses of observational studies of education level in relation to diseases studied in the present MR study. We found latest published meta-analysis on 13 diseases and two risk factors, including major depressive disorders 42 , suicide attempts 43 , posttraumatic stress disorder 44 , amyotrophic lateral sclerosis 45 , Alzheimer’s disease 46 , coronary artery disease 47 , heart failure 48 , stroke 49 , breast cancer 50 , prostate cancer 51 , lung cancer 52 , type 2 diabetes 53 , chronic kidney disease 54 , body mass index 55 and hypertension (blood pressure) 56 . We extracted publication data (PMID number, the first author’s name and year of publication), sample size, and risk estimates with their corresponding confidence intervals.…”

Section: Methodsmentioning

confidence: 99%

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Health-related effects of education level: a Mendelian randomization study

Yuan

Xiong²,

Michaëlsson

et al. 2020

Preprint

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Background A deeper understanding of the causal links from education level to health outcomes may shed a light for disease prevention at a novel and efficient perspective. Methods We conducted a wide-angled Mendelian randomization to disentangle the causal role of education level from intelligence for 31 health outcomes and explore to what extent body mass index and smoking mediate the associations. Univariable and multivariable Mendelian randomization analyses were performed. Results Genetically higher education level was associated with lower risk of major mental disorders and most somatic diseases independent of intelligence. The intelligence-adjusted odds ratios for each additional standard deviation of education (4.2 years) were 0.48 (0.37, 0.62) for suicide attempts, 0.50 (0.36, 0.68) for large artery stroke, 0.51 (0.42, 0.63) for heart failure, 0.52 (0.42, 0.65) for lung cancer, 0.45 (0.33,0.61) for rheumatoid arthritis, and 0.48 (0.43, 0.55) for type 2 diabetes. Higher education level adjusted for intelligence was additionally associated with lower risk of insomnia, major depressive disorder, stroke, coronary artery disease, breast cancer, ovarian cancer and gout but with higher risk of obsessive-compulsive disorder, anorexia nervosa, bipolar disorder and prostate cancer. Moreover, higher education level was associated with modifiable health-related risk factors in a favorable manner. Adjustment for body mass index and smoking attenuated the associations between education level and several outcomes, especially for type 2 diabetes and heart failure. High education level exerts causal protective effects on major somatic diseases. Conclusions These findings emphasize the importance of education to reduce the burden of common diseases.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Health-related effects of education level: a Mendelian randomization study

Yuan

Xiong²,

Michaëlsson

et al. 2020

Preprint

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“…In the UK, prevalence of heart failure standardized by age and sex was 2.0% in the most socioeconomically deprived vs. 1.2% in the least deprived (adjusted rate ratio 1.57, 95% CI 1.55–1.58) based on hospital and primary care data 27 . A recent meta‐analysis of 11 studies found that low socioeconomic status assessed by all common measures (education, income, occupation and area) independently increases risk of incident heart failure by 62%, overall 123 . Although heart failure incidence declined evenly across all socioeconomic strata in the UK, age at first diagnosis differed significantly between the highest and lowest socioeconomic quintiles, and this gap in age widened over time 27 …”

Section: Aetiology Of Heart Failurementioning

confidence: 99%

Epidemiology of heart failure

Groenewegen

Rutten

Mosterd

et al. 2020

European J of Heart Fail

1,222

937

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The heart failure syndrome has first been described as an emerging epidemic about 25 years ago. Today, because of a growing and ageing population, the total number of heart failure patients still continues to rise. However, the case mix of heart failure seems to be evolving. Incidence has stabilized and may even be decreasing in some populations, but alarming opposite trends have been observed in the relatively young, possibly related to an increase in obesity. In addition, a clear transition towards heart failure with a preserved ejection fraction has occurred. Although this transition is partially artificial, due to improved recognition of heart failure as a disorder affecting the entire left ventricular ejection fraction spectrum, links can be made with the growing burden of obesity-related diseases and with the ageing of the population. Similarly, evidence suggests that the number of patients with heart failure may be on the rise in low-income countries struggling under the double burden of communicable diseases and conditions associated with a Western-type lifestyle. These findings, together with the observation that the mortality rate of heart failure is declining less rapidly than previously, indicate we have not reached the end of the epidemic yet. In this review, the evolving epidemiology of heart failure is put into perspective, to discern major trends and project future directions.

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“…Their findings are consistent with other similar analyses evaluating the association between socioeconomic status (SES) and cardiovascular disease. Low SES is associated with a greater risk for incident heart failure, 5 and among patients with heart failure a post-hoc analysis from two clinical trials found similar results with respect to country-level socioeconomic deprivation and mortality. 6 While these results may be subject to selection bias related to regional factors or highly selective clinical trial enrollment criteria, similar findings were seen in an analysis from a prospectively enrolled international cohort of patients with AHF.…”

mentioning

confidence: 79%