The role of social and economic factors in the prevention of cardiovascular disease

Abstract

In the industrialized nations, a lower socioeconomic status (SES) is associated with higher cardiovascular (CV) morbidity and mortality as a result of a higher prevalence of smoking, overweight and obesity, lower physical activity, higher blood pressure, more frequent hyperlipidemia and diabetes, adverse psychosocial factors (social exclusion, stress, depression, anxiousness, hostility) and poorer patients' compliance with physician's instructions regarding prevention and treatment among individuals of lower social standing. Conventional CV risk factors will explain about half of the social gradient in the coronary heart disease (CHD) risk; CV prevention among individuals of lower SES is less successful and requires modified strategies and specific programs. Unlike intervention of conventional risk factors, that of psychosocial factors fails to reduce CV morbidity and mortality significantly. The SCORE tables of CV risk do not take into account SES and underestimate the risk with individuals of low social standing. It is just these individuals and the disadvantaged ones, with a low level of education, and those resident in problem-ridden areas and regions that preventive cardiology should give increased attention to.