International Journal of Epidemiology, Vol 26, 516-522, Copyright © 1997 by International Epidemiological Association
P Suadicani, HO Hein and F Gyntelberg
OBJECTIVE: Large social inequalities exist in risk of ischaemic heart
disease (IHD) in Western populations; inequalities which are only little
accounted for by established risk factors. We wished to find out if some
newly identified cardiovascular risk factors in concert with established
factors might contribute further to the explanation. DESIGN AND SETTING: A
6-year follow-up in the Copenhagen Male Study. SUBJECTS: Some 2974 males
aged 53-75 years (mean 63) without overt cardiovascular disease were
included in the study. Potential confounders included were: alcohol,
physical activity, smoking, serum lipids, serum cotinine, serum selenium,
lifetime occupational exposure to soldering fumes and organic solvents,
body mass index, blood pressure, hypertension, use of sugar in hot
beverages, use of diuretics, and Lewis phenotypes. MAIN OUTCOME MEASURES:
During the 6-year follow-up period (1985/1986-1991), 184 men (6.2%) had a
first IHD event. Compared to higher social classes (classes I, II and III),
lower classes (classes IV and V) had a significantly (P < 0.05)
increased risk of IHD; age-adjusted relative risk (RR) with 95% confidence
limits was 1.44 (1.1-1.9), P = 0.02. After multivariate adjustment for age,
blood pressure, serum lipids, physical activity, and smoking, the RR
dropped to 1.38 (1.0-1.9), P = 0.05. Some newly identified risk factors
were significantly associated with increased risk of IHD as well as with
low social class: a low serum selenium concentration, a low level of
leisure time physical activity in midlife, long-term exposure to soldering
fumes, and abstention from or a low consumption of wine and strong spirits.
After adjustment for these factors also, the RR dropped to 1.12 (P = 0.54).
CONCLUSIONS: The results of this study suggest that potentially modifiable
risk factors associated with lifestyle and working environment are strong
mediators of social inequalities in risk of ischaemic heart disease.
ARTICLES
Strong mediators of social inequalities in risk of ischaemic heart disease: a six-year follow-up in the Copenhagen Male Study
Department of Occupational Medicine, Copenhagen University Hospital, Denmark.
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