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oai:repisalud.isciii.es:20.500.12105/83482024-10-31T11:48:57Zcom_20.500.12105_19604com_20.500.12105_2051col_20.500.12105_19605

00925njm 22002777a 4500 dc Redondo-Bravo, Lidia author Fernandez-Alvira, Juan Miguel author Gorriz, Juan author Mendiguren, Jose M author Sanz, Javier author Fernandez-Friera, Leticia author Garcia-Ruiz, Jose M author Fernandez-Ortiz, Antonio author Ibáñez, Borja author Bueno, Hector author Fuster, Valentin author 2019-07 BACKGROUND: Socioeconomic status (SES)-education, income level, and occupation-is associated with cardiovascular risk. OBJECTIVES: This study aimed to investigate the association between SES and subclinical atherosclerosis and the potential mechanisms involved. METHODS: SES, lifestyle habits (smoking, dietary patterns, physical activity, and hours of sleep), traditional risk factors, and subclinical atherosclerosis extent were prospectively assessed in 4,025 individuals aged 40 to 54 years without known cardiovascular disease enrolled in the PESA (Progression of Early Subclinical Atherosclerosis) study. After factors associated with atherosclerosis were identified, a multiple mediation model was created to quantify the effect of SES on subclinical atherosclerosis as explained by lifestyle behaviors. RESULTS: Although education level was significantly associated with the presence of atherosclerosis, no differences were found according to income level in this population. Participants with lower education presented with a higher risk of generalized atherosclerosis than those with higher education (odds ratio: 1.46; 95% confidence interval: 1.15 to 1.85; p = 0.002). Lifestyle behaviors associated with both education level and atherosclerosis extent were: smoking status, number of cigarettes/day, and dietary pattern, which explained 70.5% of the effect of SES on atherosclerosis. Of these, tobacco habit (smoking status 35% and number of cigarettes/day 32%) accounted for most of the explained differences between groups, whereas dietary pattern did not remain a significant mediator in the multiple mediation model. CONCLUSIONS: Despite the relative economic homogeneity of the cohort, lower education level is associated with increased subclinical atherosclerosis, mainly mediated by the higher and more frequent tobacco consumption. Smoking cessation programs are still needed, particularly in populations with lower education level. J Am Coll Cardiol. 2019; 74(4):526-535 10.1016/j.jacc.2019.05.042 1558-3597 0735-1097 Journal of the American College of Cardiology 31345427 http://hdl.handle.net/20.500.12105/8348 Atherosclerosis Education Mediation model Smoking Socioeconomic status Does Socioeconomic Status Influence the Risk of Subclinical Atherosclerosis?: A Mediation Model