I can't quite see how your doctor is going to address this risk factor.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=167321&CultureCode=en
Low socioeconomic status is associated with a higher risk
of a second heart attack or stroke, according to research presented at
ESC Congress 2016 today.1 The study in nearly 30 000 patients with a
prior heart attack found that the risk of a second event was 36% lower
for those in the highest income quintile compared to the lowest and
increased by 14% in divorced compared to married patients.
Lead author Dr Joel Ohm, a physician at the Karolinska University
Hospital and Karolinska Institutet in Stockholm, Sweden, said: “Are you
rich or poor? Married or divorced? That might affect your risk of a
second heart attack or stroke. Advances in prevention and acute
treatment have increased survival after heart attack and stroke over the
past several decades. The result is that more people live with
cardiovascular disease – in Sweden almost one fifth of the total
population is in this group.”
Most research on cardiovascular prevention is based on healthy people
and it is unclear if the findings apply to patients with established
disease. An association between socioeconomic status in healthy
individuals and future cardiovascular disease was found in the 1950s.
This study investigated the link between socioeconomic status in
patients who had survived a first heart attack and the risk of a second
heart attack or a stroke.
The study included 29 953 patients from the Swedish nationwide
registry, Secondary Prevention after Heart Intensive Care Admission
(SEPHIA), who had been discharged approximately one year previously from
a cardiac intensive care unit after treatment for a first myocardial
infarction. Data on outcome over time and socioeconomic status (defined
as disposable income, marital status and level of education) was
obtained from Statistics Sweden and the National Board of Health and
Welfare.
During an average follow up of four years, 2405 patients (8%)
suffered a heart attack or stroke. After adjusting for age, gender,
smoking status, and the defined measures of socioeconomic status, being
divorced was independently associated with a 14% greater risk of a
second event than being married. There was an independent and linear
relationship between disposable income and the risk of a second event,
with those in the highest quintile of income having a 36% lower risk
than those in the lowest quintile (figures 1 and 2). A higher level of
education was associated with a lower risk of events but the association
was not significant after adjustment for income.
Dr Ohm said: “Our study shows that in the years following a first
myocardial infarction, men and women with low socioeconomic status have a
higher risk of suffering another heart attack or stroke. This is a new
finding and suggests that socioeconomic status should be included in
risk assessment for secondary prevention after a heart attack. Even
though health care providers are unlikely to keep track of their
patients’ yearly salary, simple questions about other socioeconomic
variables such as marital status and educational level could make a
difference.”
According to the widely used assessment tools for cardiovascular
risk, survivors of heart attacks are at the highest possible risk for
subsequent events regardless of other risk factors. There is, for
example, no difference in estimated risk level between a previously
healthy 40-year old female from Spain and a heavily smoking, obese,
elderly man with diabetes and high blood pressure from Finland.
Dr Ohm said: “Risk assessment tools are designed for individuals
without previous cardiovascular disease and the calculations may not
apply to patients with established cardiovascular disease. Socioeconomic
status is perhaps a better marker to assess risk of future events in
heart attack patients and more research is needed to determine other
factors that could be included, such as occupation or residential area.”
Figure 1. Relationship between disposable income and risk of a second heart attack or stroke.
Results are adjusted for age, gender, smoking and other socioeconomic variables (marital status and education level).
Figure 2. Proportion of patients free of a second incident heart
attack or stroke (ASCVD or atherosclerotic cardiovascular disease)
during follow-up time by quintiles of disposable income.
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