Pocock S J, Shaper A G, Cook D G, Phillips A N, Walker M
Lancet. 1987 Jul 25;2(8552):197-201. doi: 10.1016/s0140-6736(87)90774-4.
To examine why ischaemic heart disease (IHD) mortality rates in Britain are higher in manual than in non-manual workers 7735 middle-aged men in the British Regional Heart Study were followed up for 6 years, during which time 336 men experienced a major IHD event (fatal or non-fatal myocardial infarction or sudden cardiac death). The prevalence rates of IHD at screening, were higher in manual workers. Also, the attack rate of major IHD events during follow-up was 44% higher in manual workers. Marked differences in cigarette smoking contributed substantially to the increased risk of IHD in manual workers, who also had higher levels of blood pressure, were more obese, and took much less physical activity in leisure time. Adjustment for differences in these risk factors narrowed the gap between manual and non-manual workers in attack rates of IHD. Since the risk of IHD in Great Britain is high in all social classes, there would seem to be little justification for any overall policy for prevention of IHD to focus on social class. However, anti-smoking strategies might well take into account the social class differences described.
为研究为何英国体力劳动者的缺血性心脏病（IHD）死亡率高于非体力劳动者，英国地区心脏研究对7735名中年男性进行了为期6年的随访，在此期间，336名男性发生了重大IHD事件（致命或非致命性心肌梗死或心源性猝死）。筛查时IHD的患病率在体力劳动者中较高。此外，随访期间体力劳动者重大IHD事件的发作率高出44%。吸烟方面的显著差异在很大程度上导致了体力劳动者患IHD风险的增加，他们还具有更高的血压水平、更肥胖，且休闲时间的体力活动少得多。对这些风险因素差异进行调整后，体力劳动者和非体力劳动者在IHD发作率上的差距缩小。由于英国所有社会阶层的IHD风险都很高，似乎没有什么理由让任何预防IHD的总体政策侧重于社会阶层。然而，反吸烟策略很可能要考虑到所描述的社会阶层差异。
