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Socioeconomic inequalities in coronary heart disease risk in older age: Contribution of established and novel coronary risk factors

Lookup NU author(s): Professor Sheena Ramsay



This is the final published version of an article that has been published in its final definitive form by Wiley-Blackwell, 2009.

For re-use rights please refer to the publisher's terms and conditions.


Background: Evidence on socioeconomic inequalities in coronary heart disease (CHD) and their pathways in the elderly is limited. Little is also known about the contributions that novel coronary risk factors (particularly inflammatory/hemostatic markers) make to socioeconomic inequalities in CHD. Objectives: To examine the extent of socioeconomic inequalities in CHD in older age, and the contributions (relative and absolute) of established and novel coronary risk factors. Methods: A population-based cohort of 3761 British men aged 60-79 years was followed up for 6.5 years for CHD mortality and incidence (fatal and non-fatal). Social class was based on longest-held occupation recorded at 40-59 years. Results: There was a graded relationship between social class and CHD incidence. The hazard ratio for CHD incidence comparing social class V (unskilled workers) with social class I (professionals) was 2.70 [95% confidence interval (CI) 1.37-5.35; P-value for trend = 0.008]. This was reduced to 2.14 (95% CI 1.06-4.33; P-value for trend = 0.11) after adjustment for behavioral factors (cigarette smoking, physical activity, body mass index, and alcohol consumption), which explained 38% of the relative risk gradient (41% of absolute risk). Additional adjustment for inflammatory markers (C-reactive protein, interleukin-6, and von Willebrand factor) explained 55% of the relative risk gradient (59% of absolute risk). Blood pressure and lipids made little difference to these estimates; results were similar for CHD mortality. Conclusions: Socioeconomic inequalities in CHD persist in the elderly and are at least partly explained by behavioral risk factors; novel (inflammatory) coronary risk markers made some further contribution. Reducing inequalities in behavioral factors (especially cigarette smoking) could reduce these social inequalities by at least one-third. © 2009 International Society on Thrombosis and Haemostasis.

Publication metadata

Author(s): Ramsay SE, Morris RW, Whincup PH, Papacosta O, Rumley A, Lennon L, Lowe G, Wannamethee SG

Publication type: Article

Publication status: Published

Journal: Journal of Thrombosis and Haemostasis

Year: 2009

Volume: 7

Issue: 11

Pages: 1779-1786

Print publication date: 01/11/2009

Online publication date: 21/10/2009

Date deposited: 14/06/2017

ISSN (print): 1538-7933

ISSN (electronic): 1538-7836

Publisher: Wiley-Blackwell


DOI: 10.1111/j.1538-7836.2009.03602.x

PubMed id: 20015318


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