TITLE

C-reactive protein, established risk factors and social inequalities in cardiovascular disease - the significance of absolute versus relative measures of disease

AUTHOR(S)
Rosvall, Maria; Engström, Gunnar; Berglund, Göran; Hedblad, Bo
PUB. DATE
January 2008
SOURCE
BMC Public Health;2008, Vol. 8, p189
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The widespread use of relative scales in socioepidemiological studies has recently been criticized. The criticism is based mainly on the fact that the importance of different risk factors in explaining social inequalities in cardiovascular disease (CVD) varies, depending on which scale is used to measure social inequalities. The present study examines the importance of established risk factors, as opposed to low-grade inflammation, in explaining socioeconomic differences in the incidence of CVD, using both relative and absolute scales. Methods: We obtained information on socioeconomic position (SEP), established risk factors (smoking, hypertension, and hyperlipidemia), and low-grade inflammation as measured by high-sensitive (hs) C-reactive protein (CRP) levels, in 4,268 Swedish men and women who participated in the Malmö Diet and Cancer Study (MDCS). Data on first cardiovascular events, i.e., stroke or coronary event (CE), was collected from regional and national registers. Social inequalities were measured in relative terms, i.e., as ratios between incidence rates in groups with lower and higher SEP, and also in absolute terms, i.e., as the absolute difference in incidence rates in groups with lower and higher SEP. Results: Those with low SEP had a higher risk of future CVD. Adjustment for risk factors resulted in a rather small reduction in the relative socioeconomic gradient, namely 8% for CRP (⩾?3 mg/L) and 21% for established risk factors taken together. However, there was a reduction of 18% in the absolute socioeconomic gradient when looking at subjects with CRP-levels < 3 mg/L, and of 69% when looking at a low-risk population with no smoking, hypertension, or hyperlipidemia. Conclusion: C-reactive protein and established risk factors all contribute to socioeconomic differences in CVD. However, conclusions on the importance of "modern" risk factors (here, CRP), as opposed to established risk factors, in the association between SEP and CVD depend on the scale on which social inequalities are measured. The one-sided use of the relative scale, without including a background of absolute levels of disease, and of what causes disease, can consequently prevent efforts to reduce established risk factors by giving priority to research and preventive programs looking in new directions.
ACCESSION #
51485513

 

Related Articles

  • Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. ZIMMERMANN, JOSEF; HERRLINGER, SILKE; PRUY, ANTJE; METZGER, THOMAS; WANNER, CHRISTOPH // Kidney International;Feb1999, Vol. 55 Issue 2, p648 

    Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Background. Atherosclerosis, a major problem in patients on chronic hemodialysis, has been characterized as an inflammatory disease. C-reactive protein (CRP), the prototypical acute phase protein in humans, is a...

  • Association Between Cholesterol Level and Mortality in Dialysis Patients: Role of Inflammation and Malnutrition. Yongmei Liu; Coresh, Josef; Eustace, Joseph A.; Longenecker, J. Craig; Jaar, Bernard; Fink, Nancy E.; Tracy, Russell P.; Powe, Neil R.; Klag, Michael J. // JAMA: Journal of the American Medical Association;1/28/2004, Vol. 291 Issue 4, p451 

    Context: Total cholesterol level is inversely associated with mortality in dialysis patients, a group at high risk of cardiovascular disease (CVD). This paradox may be explained by systemic inflammation and/or malnutrition, which are associated with lower cholesterol levels and higher mortality....

  • Relationship between components of the metabolic syndrome and job strain using a brief job stress questionnaire (BJSQ). Kawada, Tomoyuki // International Archives of Occupational & Environmental Health;Aug2013, Vol. 86 Issue 6, p725 

    A letter to the editor is presented in response to the article "The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review," by E. M. Backe and colleagues in the 2012 issue.

  • Dietary fat intake and prevention of cardiovascular disease. Hooper, Lee; Summerbell, Carolyn D.; Higgins, Julian P. T.; Thompson, Rachel L.; Capps, Nigel E.; Smith, George Davey; Riemersma, Rudolph A.; Ebrahim, Shah // BMJ: British Medical Journal (International Edition);03/31/2001, Vol. 322 Issue 7289, p757 

    Assesses the effect of reduction or modification of dietary fat intake on total and cardiovascular mortality and cardiovascular morbidity. Methods; Results; Conclusion that there is a small but potentially important reduction in cardiovascular risk with reduction or modification of dietary fat...

  • Hyperglycemia Increases Cardiovascular Disease Risk. Miller, Karl E. // American Family Physician;9/15/2005, Vol. 72 Issue 6, p1106 

    Discusses research being done on whether nondiabetic hyperglycemia is an independent risk factor for cardiovascular disease. Reference to a study by E. B. Levitan and colleagues published in the October 25, 2004 issue of "Archives of Internal Medicine" journal; Analysis of medical research...

  • The relation of metabolic syndrome according to five definitions to cardiovascular risk factors - a population-based study. Cheng-Chieh Lin; Chiu-Shong Liu; Chia-Ing Li; Wen-Yuan Lin; Ming-May Lai; Tsann Lin; Pei-Chia Chang; Yih-Dar Lee; Ching-Chu Chen; Chih-Hsueh Lin; Chuan-Wei Yang; Chih-Yi Hsiao; Chen, Walter; Tsai-Chung Li // BMC Public Health;2009, Vol. 9, p484 

    Background: Although National Cholesterol Education Program (NCEP), International Diabetes Federation (IDF), American Heart Association and National Heart, Lung and Blood Institute (AHA/NHLBI), World Health Organization (WHO), and the European Group for the Study of Insulin Resistance (EGIR)...

  • Rationale and methods of the cardiometabolic valencian study (escarval-risk) for validation of risk scales in mediterranean patients with hypertension, diabetes or dyslipidemia. Gil-Guillen, Vicente; Orozco-Beltran, Domingo; Redon, Josep; Pita-Fernandez, Salvador; Navarro-Pérez, Jorge; Pallares, Vicente; Valls, Francisco; Fluixa, Carlos; Fernandez, Antonio; Martin-Moreno, Jose M; Pascual-de-la-Torre, Manuel; Trillo, Jose L.; Durazo-Arvizu, Ramon; Cooper, Richard; Hermenegildo, Marta; Rosado, Luis // BMC Public Health;2010, Vol. 10, p717 

    Background: The Escarval-Risk study aims to validate cardiovascular risk scales in patients with hypertension, diabetes or dyslipidemia living in the Valencia Community, a European Mediterranean region, based on data from an electronic health recording system comparing predicted events with...

  • Scots 'have first stroke earlier'.  // GP: General Practitioner;5/23/2008, p10 

    The article reports on a study which opposes the claims that the rate of first hospitalisation for stroke has fallen in Scotland since the 1990s. It relates that an analysis of data from the Scottish Linked Morbidity Record Database indicates that claims proves to be untrue maybe because people...

  • Do prescription stimulants increase the risk of adverse cardiovascular events?: A systematic review.  // BMC Cardiovascular Disorders;2012, Vol. 12 Issue 1, p41 

    The article presents the findings of a systematic review conducted on examining whether prescription stimulants increase the risk of adverse cardiovascular events. It discusses the methodology of the research. It reveals that the association between prescription stimulant use and adverse...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics