Association of lifelong occupation and educational level with subclinical atherosclerosis in different European regions. Results from the IMPROVE study

Calogero C Tedesco, Fabrizio Veglia, Ulf de Faire, Sudhir Kurl, Andries J Smit, Rainer Rauramaa, Philippe Giral, Mauro Amato, Alice Bonomi, Alessio Ravani, Beatrice Frigerio, Samuela Castelnuovo, Daniela Sansaro, Elmo Mannarino, Steve E Humphries, Anders Hamsten, Elena Tremoli, Damiano Baldassarre, IMPROVE study group

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND AIMS: We aimed to examine the association between socioeconomic status (SES) and subclinical atherosclerosis, as assessed by carotid intima-media-thickness (C-IMT) and to investigate whether the effect of social inequality on C-IMT is mediated by cardiovascular (CV) risk factors and whether it is dissimilar in men and women, and in different European countries.

METHODS: We assessed the association of lifelong occupation and educational level with C-IMT in the IMPROVE study cohort including 3703 subjects (median age 64.4 years; 48% men) from Southern (Italy), Western (France and the Netherlands) and Northern Europe (Finland and Sweden). Three summary measures of C-IMT (IMTmean, IMTmax, IMTmean-max), obtained from four segments of both carotids, were considered.

RESULTS: After adjusting for conventional CV risk factors, current employment status and diet, C-IMT was higher in manual workers than in white collars (+7.7%, +5.3%, +4.6% for IMTmax, IMTmean-maxand IMTmean, respectively; all p<.0001). Similar results were obtained by stratification for educational level. The effect of occupation on C-IMT was comparable in men and women and in different age groups, and was only partially mediated by differences in CV risk factors. Of note, the association of C-IMT with occupation was significant in Western and Northern Europe but not in Italy, with a significant statistical interaction (p = .0005).

CONCLUSIONS: Low SES was associated with subclinical atherosclerosis in subjects with at least three CV risk factors. Such association was stronger in Northern and Western Europe than in Italy. This difference was not completely explained by inequalities in CV risk factors and behavioural variables.

Original languageEnglish
Pages (from-to)129-137
Number of pages9
JournalAtherosclerosis
Volume269
DOIs
Publication statusPublished - Feb 2018

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Carotid Intima-Media Thickness
Occupations
Atherosclerosis
Italy
Social Class
Finland
Sweden
Netherlands
France
Cohort Studies
Age Groups
Diet

Keywords

  • Journal Article

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Association of lifelong occupation and educational level with subclinical atherosclerosis in different European regions. Results from the IMPROVE study. / Tedesco, Calogero C; Veglia, Fabrizio; de Faire, Ulf; Kurl, Sudhir; Smit, Andries J; Rauramaa, Rainer; Giral, Philippe; Amato, Mauro; Bonomi, Alice; Ravani, Alessio; Frigerio, Beatrice; Castelnuovo, Samuela; Sansaro, Daniela; Mannarino, Elmo; Humphries, Steve E; Hamsten, Anders; Tremoli, Elena; Baldassarre, Damiano; IMPROVE study group.

In: Atherosclerosis, Vol. 269, 02.2018, p. 129-137.

Research output: Contribution to journalArticle

Tedesco, Calogero C ; Veglia, Fabrizio ; de Faire, Ulf ; Kurl, Sudhir ; Smit, Andries J ; Rauramaa, Rainer ; Giral, Philippe ; Amato, Mauro ; Bonomi, Alice ; Ravani, Alessio ; Frigerio, Beatrice ; Castelnuovo, Samuela ; Sansaro, Daniela ; Mannarino, Elmo ; Humphries, Steve E ; Hamsten, Anders ; Tremoli, Elena ; Baldassarre, Damiano ; IMPROVE study group. / Association of lifelong occupation and educational level with subclinical atherosclerosis in different European regions. Results from the IMPROVE study. In: Atherosclerosis. 2018 ; Vol. 269. pp. 129-137.
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title = "Association of lifelong occupation and educational level with subclinical atherosclerosis in different European regions. Results from the IMPROVE study",
abstract = "BACKGROUND AND AIMS: We aimed to examine the association between socioeconomic status (SES) and subclinical atherosclerosis, as assessed by carotid intima-media-thickness (C-IMT) and to investigate whether the effect of social inequality on C-IMT is mediated by cardiovascular (CV) risk factors and whether it is dissimilar in men and women, and in different European countries.METHODS: We assessed the association of lifelong occupation and educational level with C-IMT in the IMPROVE study cohort including 3703 subjects (median age 64.4 years; 48{\%} men) from Southern (Italy), Western (France and the Netherlands) and Northern Europe (Finland and Sweden). Three summary measures of C-IMT (IMTmean, IMTmax, IMTmean-max), obtained from four segments of both carotids, were considered.RESULTS: After adjusting for conventional CV risk factors, current employment status and diet, C-IMT was higher in manual workers than in white collars (+7.7{\%}, +5.3{\%}, +4.6{\%} for IMTmax, IMTmean-maxand IMTmean, respectively; all p<.0001). Similar results were obtained by stratification for educational level. The effect of occupation on C-IMT was comparable in men and women and in different age groups, and was only partially mediated by differences in CV risk factors. Of note, the association of C-IMT with occupation was significant in Western and Northern Europe but not in Italy, with a significant statistical interaction (p = .0005).CONCLUSIONS: Low SES was associated with subclinical atherosclerosis in subjects with at least three CV risk factors. Such association was stronger in Northern and Western Europe than in Italy. This difference was not completely explained by inequalities in CV risk factors and behavioural variables.",
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author = "Tedesco, {Calogero C} and Fabrizio Veglia and {de Faire}, Ulf and Sudhir Kurl and Smit, {Andries J} and Rainer Rauramaa and Philippe Giral and Mauro Amato and Alice Bonomi and Alessio Ravani and Beatrice Frigerio and Samuela Castelnuovo and Daniela Sansaro and Elmo Mannarino and Humphries, {Steve E} and Anders Hamsten and Elena Tremoli and Damiano Baldassarre and {IMPROVE study group}",
note = "Copyright {\circledC} 2017. Published by Elsevier B.V.",
year = "2018",
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TY - JOUR

T1 - Association of lifelong occupation and educational level with subclinical atherosclerosis in different European regions. Results from the IMPROVE study

AU - Tedesco, Calogero C

AU - Veglia, Fabrizio

AU - de Faire, Ulf

AU - Kurl, Sudhir

AU - Smit, Andries J

AU - Rauramaa, Rainer

AU - Giral, Philippe

AU - Amato, Mauro

AU - Bonomi, Alice

AU - Ravani, Alessio

AU - Frigerio, Beatrice

AU - Castelnuovo, Samuela

AU - Sansaro, Daniela

AU - Mannarino, Elmo

AU - Humphries, Steve E

AU - Hamsten, Anders

AU - Tremoli, Elena

AU - Baldassarre, Damiano

AU - IMPROVE study group

N1 - Copyright © 2017. Published by Elsevier B.V.

PY - 2018/2

Y1 - 2018/2

N2 - BACKGROUND AND AIMS: We aimed to examine the association between socioeconomic status (SES) and subclinical atherosclerosis, as assessed by carotid intima-media-thickness (C-IMT) and to investigate whether the effect of social inequality on C-IMT is mediated by cardiovascular (CV) risk factors and whether it is dissimilar in men and women, and in different European countries.METHODS: We assessed the association of lifelong occupation and educational level with C-IMT in the IMPROVE study cohort including 3703 subjects (median age 64.4 years; 48% men) from Southern (Italy), Western (France and the Netherlands) and Northern Europe (Finland and Sweden). Three summary measures of C-IMT (IMTmean, IMTmax, IMTmean-max), obtained from four segments of both carotids, were considered.RESULTS: After adjusting for conventional CV risk factors, current employment status and diet, C-IMT was higher in manual workers than in white collars (+7.7%, +5.3%, +4.6% for IMTmax, IMTmean-maxand IMTmean, respectively; all p<.0001). Similar results were obtained by stratification for educational level. The effect of occupation on C-IMT was comparable in men and women and in different age groups, and was only partially mediated by differences in CV risk factors. Of note, the association of C-IMT with occupation was significant in Western and Northern Europe but not in Italy, with a significant statistical interaction (p = .0005).CONCLUSIONS: Low SES was associated with subclinical atherosclerosis in subjects with at least three CV risk factors. Such association was stronger in Northern and Western Europe than in Italy. This difference was not completely explained by inequalities in CV risk factors and behavioural variables.

AB - BACKGROUND AND AIMS: We aimed to examine the association between socioeconomic status (SES) and subclinical atherosclerosis, as assessed by carotid intima-media-thickness (C-IMT) and to investigate whether the effect of social inequality on C-IMT is mediated by cardiovascular (CV) risk factors and whether it is dissimilar in men and women, and in different European countries.METHODS: We assessed the association of lifelong occupation and educational level with C-IMT in the IMPROVE study cohort including 3703 subjects (median age 64.4 years; 48% men) from Southern (Italy), Western (France and the Netherlands) and Northern Europe (Finland and Sweden). Three summary measures of C-IMT (IMTmean, IMTmax, IMTmean-max), obtained from four segments of both carotids, were considered.RESULTS: After adjusting for conventional CV risk factors, current employment status and diet, C-IMT was higher in manual workers than in white collars (+7.7%, +5.3%, +4.6% for IMTmax, IMTmean-maxand IMTmean, respectively; all p<.0001). Similar results were obtained by stratification for educational level. The effect of occupation on C-IMT was comparable in men and women and in different age groups, and was only partially mediated by differences in CV risk factors. Of note, the association of C-IMT with occupation was significant in Western and Northern Europe but not in Italy, with a significant statistical interaction (p = .0005).CONCLUSIONS: Low SES was associated with subclinical atherosclerosis in subjects with at least three CV risk factors. Such association was stronger in Northern and Western Europe than in Italy. This difference was not completely explained by inequalities in CV risk factors and behavioural variables.

KW - Journal Article

U2 - 10.1016/j.atherosclerosis.2017.12.023

DO - 10.1016/j.atherosclerosis.2017.12.023

M3 - Article

C2 - 29353228

VL - 269

SP - 129

EP - 137

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -