Rosvall Maria, Ostergren Per-Olof, Hedblad Bo, Isacsson Sven-Olof, Janzon Lars, Berglund Göran
Department of Community Medicine, University Hospital Malmo, SE-20502 Malmo, Sweden.
Soc Sci Med. 2006 Apr;62(7):1785-98. doi: 10.1016/j.socscimed.2005.08.037. Epub 2005 Sep 19.
While the persistence of socioeconomic differences in cardiovascular disease (CVD) has been recognized for many years, less is known about whether socioeconomic factors are of importance to CVD before symptoms of the disease appear. In this study the associations among educational level, occupational status and progression of atherosclerosis were investigated in 1016 Swedish middle-aged men and women with signs of subclinical atherosclerosis, i.e., carotid plaque (defined as focal intima-media thickness (IMT) > 1.2 mm). IMT in the common carotid artery (CCA) and in the carotid bifurcation area, as well as carotid plaque score, was determined by B-mode ultrasound. Results showed only weak associations between educational level, occupational status and age-, sex- and baseline IMT-adjusted progression of IMT in the CCA. However, in the age, sex- and baseline IMT-adjusted analyses, those in unskilled manual occupations showed a significantly higher yearly progression of carotid IMT in the bifurcation area compared to those in high- or medium-level non-manual occupations. Those with primary education tended to show a higher yearly progression of carotid IMT in the bifurcation area compared to those with completed secondary education. After adjustment for risk factors, the magnitude of these associations were somewhat attenuated. Similar patterns of associations were seen for the change of carotid plaque score. We conclude that low socioeconomic status (SES) is associated with progression of atherosclerosis in a middle-aged population with signs of subclinical atherosclerosis. Even though socioeconomic differences in cardiovascular risk factor levels could explain part of the found differences in progression rate in women, the mechanisms involved remain to be further established.
虽然心血管疾病（CVD）中社会经济差异的持续存在已被认识多年，但对于社会经济因素在疾病症状出现之前对CVD是否重要却知之甚少。在本研究中，对1016名有亚临床动脉粥样硬化迹象（即颈动脉斑块，定义为局灶性内膜中层厚度（IMT）>1.2mm）的瑞典中年男性和女性，调查了教育水平、职业地位与动脉粥样硬化进展之间的关联。通过B型超声测定颈总动脉（CCA）和颈动脉分叉区域的IMT以及颈动脉斑块评分。结果显示，教育水平、职业地位与CCA中经年龄、性别和基线IMT校正后的IMT进展之间仅存在微弱关联。然而，在经年龄、性别和基线IMT校正的分析中，与从事高或中级非体力职业的人相比，从事非熟练体力职业的人在分叉区域的颈动脉IMT年进展明显更高。与完成中等教育的人相比，小学教育程度的人在分叉区域的颈动脉IMT年进展往往更高。在对危险因素进行校正后，这些关联的程度有所减弱。颈动脉斑块评分的变化也呈现出类似的关联模式。我们得出结论，在有亚临床动脉粥样硬化迹象的中年人群中，低社会经济地位（SES）与动脉粥样硬化进展相关。尽管心血管危险因素水平的社会经济差异可以部分解释在女性中发现的进展率差异，但其涉及的机制仍有待进一步确定。
