Eliminating most socioeconomic differences in coronary heart disease mortality

November 06, 2008

Current best practice interventions to reduce classic coronary risk factors, if successfully implemented in high and low income groups, could eliminate most of the socioeconomic differences in coronary heart disease mortality. These are the conclusions of authors of an Article in this week's Social Determinants of Health Special Issue of The Lancet, written by Professor Mika Kivimäki, University College London, UK, and colleagues.

The authors looked at 17186 male civil servants aged 40-69 years from 1967-1970 in the UK (the Whitehall study). Socioeconomic position was based on employment grade. They compared the potential reduction in excess coronary heart disease mortality in men of low with those of high socioeconomic position with either known best-practice interventions (reduction of systolic blood pressure by 10mm Hg, of total cholesterol by 2mmol/l, and of blood glucose by 1mmol/L in pre-diabetic people, halving the presence of non-insulin dependent diabetes; and complete cessation of cigarette smoking) or primordial prevention*.

They found that the 15-year absolute risk of death due to coronary heart disease per 100 men, standardized to age 55 years, was 11.0 for men in the low employment group and 7.5 for those in the high grade group. Population-wide best-practice interventions would reduce coronary heart disease mortality by 57%, and the difference in mortality between socioeconomic groups by 69%. For primordial prevention, the corresponding reductions would be 73% and 86%, respectively.

The authors conclude: "Our results suggest that current best-practice interventions to reduce classic coronary risk factors, if successfully implemented in both high and low socioeconomic groups, could eliminate most of the socioeconomic differences in coronary heart disease mortality. Modest further benefits would result if the classic coronary risk factors could be reduced to primordial levels for the whole population."

In an accompanying Comment, Dr Martin Tobias, Ministry of Health, Wellington, New Zealand and Professor Anthony Rodgers, University of Auckland, New Zealand, say: "Kivimäki and colleagues' key message may seem simple, but simple does not mean easy. There are enormous challenges to be overcome to deliver best-practice intervention to disadvantaged groups, who are often beset with competing priorities, resource constraints, and comorbidities. Yet Kivimäki clearly shows that, if we are serious about eliminating social inequalities in cardiovascular health, we need to concentrate our efforts on the established risk factors and focus on absolute reduction in absolute risk."
-end-
See also Editorial, which has links to all four Articles.

Professor Mika Kivimäki, University College London, UK T) +44 (0) 20 7679 8260 / +358 30 474 2709 E) m.kivimaki@ucl.ac.uk

Dr Martin Tobias, Ministry of Health, Wellington, New Zealand T) +64 4 816 4494 E) martin_tobias@moh.govt.nz

Notes to editors: *primordial prevention: risk factor levels seen in populations unexposed to modern life (e.g. non-sedentary life style and low-fat diet free of added salt and refined carbohydrates)

Full Article and Comment: http://press.thelancet.com/bestpracticeheart.pdf

Lancet

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