Jones Rebecca, Hardy Rebecca, Sattar Naveed, Deanfield John E, Hughes Alun, Kuh Diana, Murray Emily T, Whincup Peter H, Thomas Claudia
Population Health Research Institute, St George's, University of London, London, United Kingdom.
MRC Unit for Lifelong Health and Ageing, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
Atherosclerosis. 2015 Jan;238(1):70-6. doi: 10.1016/j.atherosclerosis.2014.11.011. Epub 2014 Nov 18.
Social disadvantage across the life course is associated with a greater risk of coronary heart disease (CHD) and with established CHD risk factors, but less is known about whether novel CHD risk factors show the same patterns. The Medical Research Council National Survey of Health and Development was used to investigate associations between occupational socioeconomic position during childhood, early adulthood and middle age and markers of inflammation (C-reactive protein, interleukin-6), endothelial function (E-selectin, tissue-plasminogen activator), adipocyte function (leptin, adiponectin) and pancreatic beta cell function (proinsulin) measured at 60-64 years. Life course models representing sensitive periods, accumulation of risk and social mobility were compared with a saturated model to ascertain the nature of the relationship between social class across the life course and each of these novel CHD risk factors. For interleukin-6 and leptin, low childhood socioeconomic position alone was associated with high risk factor levels at 60-64 years, while for C-reactive protein and proinsulin, cumulative effects of low socioeconomic position in both childhood and early adulthood were associated with higher (adverse) risk factor levels at 60-64 years. No associations were observed between socioeconomic position at any life period with either endothelial marker or adiponectin. Associations for C-reactive protein, interleukin-6, leptin and proinsulin were reduced considerably by adjustment for body mass index and, to a lesser extent, cigarette smoking. In conclusion, socioeconomic position in early life is an important determinant of several novel CHD risk factors. Body mass index may be an important mediator of these relationships.
一生中的社会劣势与患冠心病（CHD）的风险增加以及已确定的冠心病风险因素相关，但对于新型冠心病风险因素是否呈现相同模式，人们了解较少。医学研究理事会全国健康与发展调查被用于研究儿童期、成年早期和中年期的职业社会经济地位与60 - 64岁时测量的炎症标志物（C反应蛋白、白细胞介素-6）、内皮功能（E选择素、组织纤溶酶原激活剂）、脂肪细胞功能（瘦素、脂联素）和胰腺β细胞功能（胰岛素原）之间的关联。将代表敏感期、风险累积和社会流动性的生命历程模型与饱和模型进行比较，以确定生命历程中的社会阶层与这些新型冠心病风险因素之间关系的性质。对于白细胞介素-6和瘦素，仅儿童期社会经济地位低就与60 - 64岁时的高风险因素水平相关，而对于C反应蛋白和胰岛素原，儿童期和成年早期社会经济地位低的累积效应与60 - 64岁时更高（不利）的风险因素水平相关。在任何生命阶段的社会经济地位与内皮标志物或脂联素之间均未观察到关联。通过调整体重指数，以及在较小程度上调整吸烟情况，C反应蛋白、白细胞介素-6、瘦素和胰岛素原的关联显著降低。总之，早年的社会经济地位是几种新型冠心病风险因素的重要决定因素。体重指数可能是这些关系的重要中介因素。
