1 Functional Area of Emergency Medicine Solna, Karolinska University Hospital and Department of Medicine Solna, Karolinska Institutet, Sweden.
2 Institute of Environmental Medicine, Unit of Biostatistics, Karolinska Institutet, Sweden.
Eur J Prev Cardiol. 2018 Jun;25(9):985-993. doi: 10.1177/2047487318766646. Epub 2018 Apr 17.
Background Risk assessment post-myocardial infarction needs improvement, and risk factors derived from general populations apply differently in secondary prevention. The prediction of subsequent cardiovascular events post-myocardial infarction by socioeconomic status has previously been poorly studied. Design Swedish nationwide cohort study. Methods A total of 29,226 men and women (27%), 40-76 years of age, registered at the standardised one year revisit after a first myocardial infarction in the secondary prevention quality registry of SWEDEHEART 2006-2014. Personal-level data on socioeconomic status measured by disposable income and educational level, marital status, and the primary endpoint, first recurrent event of atherosclerotic cardiovascular disease, defined as non-fatal myocardial infarction or coronary heart disease death or fatal or non-fatal stroke were obtained from linked national registries. Results During the mean 4.1-year follow-up, 2284 (7.8%) first recurrent manifestations of atherosclerotic cardiovascular disease occurred. Both socioeconomic status indicators and marital status were associated with the primary endpoint in multivariable Cox regression models. In a comprehensively adjusted model, including secondary preventive treatment, the hazard ratio for the highest versus lowest quintile of disposable income was 0.73 (95% confidence interval 0.62-0.83). The association between disposable income and first recurrent manifestation of atherosclerotic cardiovascular disease was stronger in men as was the risk associated with being unmarried (tests for interaction P < 0.05). Conclusions Among one year survivors of a first myocardial infarction, first recurrent manifestation of atherosclerotic cardiovascular disease was predicted by disposable income, level of education and marital status. The association between disposable income and first recurrent manifestation of atherosclerotic cardiovascular disease was independent of secondary preventive treatment but further study on causal pathways is needed.
心肌梗死后的风险评估需要改进，而来自普通人群的风险因素在二级预防中的应用方式不同。社会经济地位对心肌梗死后后续心血管事件的预测此前研究甚少。
瑞典全国性队列研究。
共有 29226 名年龄在 40-76 岁的男性和女性（27%），在 2006-2014 年 SWEDEHEART 二级预防质量登记处首次心肌梗死后一年的标准化复诊中登记。从国家登记处获得了个人层面的社会经济地位数据，包括可支配收入和教育程度、婚姻状况以及主要终点（定义为非致命性心肌梗死、冠心病死亡或致命性或非致命性卒中）的复发情况。
在平均 4.1 年的随访期间，2284 人（7.8%）首次出现了动脉粥样硬化性心血管疾病的复发表现。在多变量 Cox 回归模型中，社会经济地位指标和婚姻状况均与主要终点相关。在包括二级预防治疗的综合调整模型中，可支配收入最高五分位与最低五分位相比，风险比为 0.73（95%置信区间 0.62-0.83）。可支配收入与动脉粥样硬化性心血管疾病首次复发之间的关联在男性中更强，而未婚的风险也更高（交互检验 P<0.05）。
在首次心肌梗死后一年的幸存者中，可支配收入、教育程度和婚姻状况可预测动脉粥样硬化性心血管疾病的首次复发。可支配收入与动脉粥样硬化性心血管疾病首次复发之间的关联独立于二级预防治疗，但需要进一步研究因果途径。
