Murray Emily T, Jones Rebecca, Thomas Claudia, Ghosh Arjun K, Sattar Naveed, Deanfield John, Hardy Rebecca, Kuh Diana, Hughes Alun D, Whincup Peter
Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.
National Heart and Lung Institute, Imperial College Academic Health Sciences Centre, London, United Kingdom.
PLoS One. 2016 Mar 31;11(3):e0152691. doi: 10.1371/journal.pone.0152691. eCollection 2016.
Although it is recognized that risks of cardiovascular diseases associated with heart failure develop over the life course, no studies have reported whether life course socioeconomic inequalities exist for heart failure risk. The Medical Research Council's National Survey of Health and Development was used to investigate associations between occupational socioeconomic position during childhood, early adulthood and middle age and measures of cardiac structure [left ventricular (LV) mass index and relative wall thickness (RWT)] and function [systolic: ejection fraction (EF) and midwall fractional shortening (mFS); diastolic: left atrial (LA) volume, E/A ratio and E/e' ratio)]. Different life course models were compared with a saturated model to ascertain the nature of the relationship between socioeconomic position across the life course and each cardiac marker. Findings showed that models where socioeconomic position accumulated over multiple time points in life provided the best fit for 3 of the 7 cardiac markers: childhood and early adulthood periods for the E/A ratio and E/e' ratio, and all three life periods for LV mass index. These associations were attenuated by adjustment for adiposity, but were little affected by adjustment for other established or novel cardio-metabolic risk factors. There was no evidence of a relationship between socioeconomic position at any time point and RWT, EF, mFS or LA volume index. In conclusion, socioeconomic position across multiple points of the lifecourse, particularly earlier in life, is an important determinant of some measures of LV structure and function. BMI may be an important mediator of these associations.
尽管人们认识到与心力衰竭相关的心血管疾病风险是在生命过程中逐渐形成的，但尚无研究报告心力衰竭风险在生命过程中是否存在社会经济不平等现象。医学研究委员会的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心脏结构[左心室（LV）质量指数和相对室壁厚度（RWT）]及功能[收缩期：射血分数（EF）和室壁中层缩短分数（mFS）；舒张期：左心房（LA）容积、E/A比值和E/e'比值]测量指标之间的关联。将不同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经济地位与每个心脏标志物之间关系的性质。研究结果表明，社会经济地位在生命中的多个时间点累积的模型，对7个心脏标志物中的3个提供了最佳拟合：E/A比值和E/e'比值的儿童期和成年早期，以及LV质量指数的所有三个生命阶段。通过调整肥胖因素，这些关联减弱，但调整其他既定或新的心血管代谢危险因素对其影响不大。没有证据表明在任何时间点的社会经济地位与RWT、EF、mFS或LA容积指数之间存在关系。总之，生命历程中多个时间点的社会经济地位，尤其是生命早期，是LV结构和功能某些测量指标的重要决定因素。BMI可能是这些关联的重要中介因素。
