Raitakari Olli, Pentti Jaana, Koskinen Juhani S, Mykkänen Juha, Rovio Suvi, Pahkala Katja, Juonala Markus, Lehtimäki Terho, Kähönen Mika, Kawachi Ichiro, Kivimäki Mika, Viikari Jorma, Vahtera Jussi
Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
medRxiv. 2025 Jul 8:2025.07.07.25331069. doi: 10.1101/2025.07.07.25331069.
Neighbourhood socioeconomic disadvantage is a known determinant of cardiovascular disease (CVD) risk. However, its impact on subclinical atherosclerosis across the life course remains inadequately understood. This study examined the association between cumulative neighbourhood socioeconomic disadvantage from childhood to midlife and carotid artery plaques-a marker of subclinical atherosclerosis-independent of genetic and behavioral CVD risk factors.
We analysed data from 2,051 participants in the Cardiovascular Risk in Young Finns Study, a prospective cohort followed from childhood (mean age 10.7 years in 1980) to adulthood (mean age 48.6 years in 2018-2020). Neighbourhood disadvantage was derived from national grid-based socioeconomic data and computed cumulatively across childhood/adolescence, adulthood, and the entire life course. The number of carotid artery plaques (plaque count) were assessed by standardized ultrasound imaging. Multivariable Poisson regression models were used to evaluate associations, adjusting for age, sex, individual and parental socioeconomic status, genetic predisposition, and cardiovascular risk profiles. Mediation analyses assessed the role of ideal cardiovascular health (CVH) metrics.
No cross-sectional association was found between current neighbourhood disadvantage and carotid plaque count. However, higher cumulative neighbourhood disadvantage over the life course was associated with increased plaque count (rate ratio [RR] ≈ 1.20 per 1 SD increase). This relationship persisted after controlling for parental carotid artery plaques, polygenic coronary artery disease risk score, and Framingham risk score. The effect was partially mediated by ideal CVH metrics, particularly smoking and blood pressure, which collectively explained up to 50% of the association.
Long-term exposure to neighbourhood socioeconomic disadvantage beginning in childhood is associated with subclinical atherosclerosis in midlife independently of achieved socioeconomic position. Behavioural risk factors partially mediate this link, highlighting the importance of early and sustained interventions targeting both social environments and health behaviours to mitigate cardiovascular risk.
邻里社会经济劣势是心血管疾病（CVD）风险的一个已知决定因素。然而，其在整个生命过程中对亚临床动脉粥样硬化的影响仍未得到充分理解。本研究探讨了从童年到中年累积的邻里社会经济劣势与颈动脉斑块（亚临床动脉粥样硬化的一个标志物）之间的关联，该关联独立于遗传和行为性CVD风险因素。
我们分析了芬兰年轻人心血管风险研究中2051名参与者的数据，这是一个从童年（1980年平均年龄10.7岁）到成年（2018 - 2020年平均年龄48.6岁）的前瞻性队列。邻里劣势源自基于国家网格的社会经济数据，并在童年/青少年期、成年期以及整个生命过程中进行累积计算。通过标准化超声成像评估颈动脉斑块数量（斑块计数）。使用多变量泊松回归模型评估关联，并对年龄、性别、个人及父母的社会经济地位、遗传易感性和心血管风险概况进行调整。中介分析评估了理想心血管健康（CVH）指标的作用。
未发现当前邻里劣势与颈动脉斑块计数之间存在横断面关联。然而，生命过程中累积的邻里劣势越高，斑块计数增加越明显（每增加1个标准差，率比[RR]约为1.20）。在控制了父母的颈动脉斑块、多基因冠心病风险评分和弗雷明汉风险评分后，这种关系依然存在。该效应部分由理想的CVH指标介导，特别是吸烟和血压，它们共同解释了高达50%的关联。
从童年开始长期暴露于邻里社会经济劣势与中年期的亚临床动脉粥样硬化相关，且独立于所达到的社会经济地位。行为风险因素部分介导了这种联系，凸显了针对社会环境和健康行为进行早期和持续干预以降低心血管风险的重要性。
