Steptoe A, Feldman P J, Kunz S, Owen N, Willemsen G, Marmot M
Department of Epidemiology and Public Health, University College London, UK.
Eur Heart J. 2002 Nov;23(22):1757-63. doi: 10.1053/euhj.2001.3233.
Low socioeconomic status is associated with increased cardiovascular disease risk. We hypothesized that psychobiological pathways, specifically slow recovery in blood pressure and heart rate variability following mental stress, partly mediate social inequalities in risk.
Participants were 123 men and 105 women in good health aged 47-58 years drawn from the Whitehall II cohort of British civil servants. Grade of employment was the indicator of socioeconomic status. Cardiovascular measures were monitored during performance of two behavioural tasks, and for 45 min following stress. Post-stress return of blood pressure and heart rate variability to resting levels was less complete after 45 min in the medium and low than in the high grade of employment groups. The odds of failure to return to baseline by 45 min in the low relative to the high grade of employment groups were 2.60 (95% CI 1.20-5.65) and 3.85 (1.48-10.0) for systolic and diastolic pressure, respectively, and 5.19 (1.88-18.6) for heart rate variability, adjusted for sex, age, baseline levels and reactions to tasks. Subjective ratings of task difficulty, involvement and stress did not differ by socioeconomic status.
Lower socioeconomic status is associated with delayed recovery in cardiovascular function after mental stress. Impaired recovery may reflect heightened allostatic load, and constitute a mechanism through which low socioeconomic status enhances cardiovascular disease risk.
社会经济地位低下与心血管疾病风险增加有关。我们假设心理生物学途径，特别是精神压力后血压和心率变异性恢复缓慢，部分介导了风险方面的社会不平等。
参与者来自英国公务员白厅II队列，为123名男性和105名女性，年龄在47 - 58岁之间，身体健康。就业等级是社会经济地位的指标。在两项行为任务执行期间以及压力后45分钟内监测心血管指标。与高就业等级组相比，中低就业等级组在压力后45分钟时血压和心率变异性恢复到静息水平的程度较差。相对于高就业等级组，低就业等级组在45分钟时收缩压和舒张压未能恢复到基线的比值分别为2.60（95%可信区间1.20 - 5.65）和3.85（1.48 - 10.0），心率变异性为5.19（1.88 - 18.6），对性别、年龄、基线水平和任务反应进行了调整。任务难度、参与度和压力的主观评分在社会经济地位方面没有差异。
社会经济地位较低与精神压力后心血管功能恢复延迟有关。恢复受损可能反映了更高的应激负荷，并构成了社会经济地位低下增加心血管疾病风险的一种机制。
