Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
Atherosclerosis. 2022 Oct;358:29-33. doi: 10.1016/j.atherosclerosis.2022.08.013. Epub 2022 Aug 15.
Socioeconomic status (SES) is associated with cardiovascular disease. However, the relationship between SES and atherosclerosis is not well documented. This study aims to explore this relationship.
This is a retrospective cohort study in London, Ontario Canada. It includes 6,907 subjects from a vascular prevention centre at baseline, with long term follow up from 1989 to 2021 (total ultrasound examinations 27,103). Using carotid ultrasound, the burden of atherosclerosis was measured as total plaque area (TPA). The Ontario Marginalization Index (OMI) was used to identify SES of participants' neighborhoods. We used a Bayesian hierarchical regression and mixed effects model to identify associations between SES, baseline TPA and plaque progression. In 2003, we implemented more intensive therapy of vascular risk factors after 2003 (called "Treating arteries instead of risk treating factors"); therefore, we compared our findings before and after 2003.
SES was found to have a significant association with TPA, with lower SES associated with higher TPA (adjusted odds ratio [OR] = 2.22, 95% Credible interval [CrI]: 1.37, 3.66). While we observed a higher rate of plaque progression with lower SES in those treated before 2003 (OR = 1.46, 95% CrI:1.04, 2.06), there was no significant association between plaque progression and SES after implementation more intensive therapy (OR = 0.99, 95% CrI: 0.78, 1.27).
SES has a strong association with atherosclerosis and should be considered an important risk factor in clinical practice and vascular disease research. Intensive preventive therapy can prevent plaque progression irrespective of baseline SES.
社会经济地位（SES）与心血管疾病有关。然而，SES 与动脉粥样硬化之间的关系尚未得到充分证实。本研究旨在探讨这种关系。
这是一项在加拿大安大略省伦敦进行的回顾性队列研究。它包括来自血管预防中心的 6907 名受试者，从 1989 年到 2021 年进行了长期随访（总超声检查 27103 次）。使用颈动脉超声测量动脉粥样硬化的负担作为总斑块面积（TPA）。安大略边缘化指数（OMI）用于识别参与者社区的 SES。我们使用贝叶斯分层回归和混合效应模型来识别 SES、基线 TPA 和斑块进展之间的关联。2003 年，我们在 2003 年后实施了更强化的血管危险因素治疗（称为“治疗动脉而非危险因素治疗”）；因此，我们比较了 2003 年前后的发现。
SES 与 TPA 有显著关联，SES 较低与 TPA 较高相关（调整后的优势比[OR] = 2.22，95%可信区间[CrI]：1.37，3.66）。虽然我们在 2003 年前接受治疗的患者中观察到 SES 较低与斑块进展率较高相关（OR = 1.46，95% CrI：1.04，2.06），但在实施更强化治疗后，斑块进展与 SES 之间没有显著关联（OR = 0.99，95% CrI：0.78，1.27）。
SES 与动脉粥样硬化有很强的关联，应在临床实践和血管疾病研究中被视为一个重要的危险因素。强化预防治疗可以预防斑块进展，与基线 SES 无关。
