Despite recent declines in mortality, cardiovascular diseases are the leading cause of death in the United States today. It appears that many of the major risk factors for coronary disease have been identified. Researchers are still learning about different modifiable factors that may influence cardiovascular diseases. Socioeconomic status may provide a new focus. The principal measures of SES have been education, occupation, and income or combinations of these. Education has been the most frequent measure because it does not usually change (as occupation or income might) after young adulthood, information about education can be obtained easily, and it is unlikely that poor health in adulthood influences level of education. However, other measures of SES have merit, and the most informative strategy would incorporate multiple indicators of SES. A variety of psychosocial measures--for example, certain aspects of occupational status--may be important mediators of SES and disease. The hypothesis that high job strain may adversely affect health status has a rational basis and is supported by evidence from a limited number of studies. There is a considerable body of evidence for a relation between socioeconomic factors and all-cause mortality. These findings have been replicated repeatedly for 80 years across measures of socioeconomic level and in geographically diverse populations. During 40 years of study there has been a consistent inverse relation between cardiovascular disease, primarily coronary heart disease, and many of the indicators of SES. Evidence for this relation has been derived from prevalence, prospective, and retrospective cohort studies. Of particular importance to the hypothesis that SES is a risk factor for cardiovascular disease was the finding by several investigators that the patterns of association of SES with coronary disease had changed in men during the past 30 to 40 years and that SES has been associated with the decline of coronary mortality since the mid-1960s. However, the declines in coronary mortality of the last few decades have not affected all segments of society equally. There is some evidence that areas with the poorest socioenvironmental conditions experience later onset in the decline in cardiovascular mortality. A number of studies suggest that poor living conditions in childhood and adolescence contribute to increased risk of arteriosclerosis. Some of these studies have been criticized because of their nature, and others for inadequate control of confounding factors.(ABSTRACT TRUNCATED AT 400 WORDS)

Socioeconomic factors and cardiovascular disease: a review of the literature.

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/165063/1/T999900135.pdf

Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

Objective To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes. Design Systematic review and meta-analysis. Data sources A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings. Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke. Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis. Results The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality (31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1–2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)). Conclusions Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.

https://www.bmj.com/content/bmj/342/bmj.d671.full.pdf

Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis

Background Alcohol consumption has both adverse and beneficial effects on survival. We examined the balance of these in a large prospective study of mortality among U.S. adults. Methods Of 490,000 men and women (mean age, 56 years; range, 30 to 104) who reported their alcohol and tobacco use in 1982, 46,000 died during nine years of follow-up. We compared cause-specific death rates and rates of death from all causes across categories of base-line alcohol consumption, adjusting for other risk factors, and related drinking and smoking habits to the cumulative probability of dying between the ages of 35 and 69 years. Results Causes of death associated with drinking were cirrhosis and alcoholism; cancers of the mouth, esophagus, pharynx, larynx, and liver combined; breast cancer in women; and injuries and other external causes in men. The mortality from breast cancer was 30 percent higher among women reporting at least one drink daily than among nondrinkers (relative risk, 1.3; 95 percent confidence interval,...

Alcohol Consumption and Mortality among Middle-Aged and Elderly U.S. Adults

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Raised blood pressure (BP), cholesterol and smoking, are the major risk factors. Among these, raised BP is the most important cause, accounting for 62% of strokes and 49% of coronary heart disease. Importantly, the risk is throughout the range of BP, starting at systolic 115 mm Hg. There is strong evidence that our current consumption of salt is the major factor increasing BP and thereby CVD. Furthermore, a high salt diet may have direct harmful effects independent of its effect on BP, for example, increasing the risk of stroke, left ventricular hypertrophy and renal disease. Increasing evidence also suggests that salt intake is related to obesity through soft drink consumption, associated with renal stones and osteoporosis and is probably a major cause of stomach cancer. In most developed countries, a reduction in salt intake can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. In other countries where most of the salt consumed comes from salt added during cooking or from sauces, a public health campaign is needed to encourage consumers to use less salt. Several countries have already reduced salt intake, for example, Japan (1960–1970), Finland (1975 onwards) and now the United Kingdom. The challenge is to spread this out to all other countries. A modest reduction in population salt intake worldwide will result in a major improvement in public health.

A comprehensive review on salt and health and current experience of worldwide salt reduction programmes.

Intake of spirits and beer as well as smoking was measured by questionnaire in a random population sample from two counties of Eastern Finland in 1972. At the same time serum cholesterol, triglycerides and blood pressure were measured in a field examination. The study material consists of 4063 men aged 30-59 years (participation rate 92%). During a 7-yr follow-up 209 of these men had developed an acute myocardial infarction (AMI) and 223 men had died. Reported spirits and beer intake had both a strong positive association with smoking and serum triglycerides, a weak positive association with diastolic blood pressure, but no relationship to serum total cholesterol. Use of spirits at least once a week was associated with a reduced risk of AMI. The relative risk (RR), adjusted for age and conventional coronary risk factors was 0.5 (95% confidence interval (CI), 0.3-0.9). Consumption of beer had no significant relationship to the risk of AMI. Consumption of at least five bottles of beer a week was related to a slightly excessive risk of death from any cause (adjusted RR = 1.5, 95% CI = 1.0-2.1). Spirits intake had no significant association with the risk of death.

Intake of spirits and beer and risk of myocardial infarction and death - a longitudinal study

A model programme for hypertension control in the community has been implemented in North Karelia, Finland, since 1972. The treatment status of the patients was improved and blood pressure levels were reduced during 1972 to 1977. This improvement started to level off during 1977 to 1982, although more than 10% of the population aged 35-64 years were treated with antihypertensive drugs. Several analyses were done to find out which dietary factors contributed to the blood pressure level and to its change in the community. The study material consisted of random samples of the population aged 30-59 years in two counties in Eastern Finland, who participated in the surveys in 1972, 1977 and 1982. The analyses confirmed that high BMI, high fat intake, alcohol drinking and high Na intake were associated significantly with blood pressure and also with its change both in the general population and in hypertensive persons. The high levels of these nutritional factors were also associated with unsatisfactory outcome of drug treatment in the hypertensive patients. Thus, it is likely that nutritional changes that can reduce the levels of BMI, the intake of fat, alcohol, and Na would contribute significantly both to primary prevention and to the effective treatment of elevated blood pressure in the community. In Eastern Finland the levels of alcohol intake have increased both in men and women, BMI increased in men and decreased in women and serum cholesterol levels dropped both in men and women between 1972 to 1982. The results of a community-based programme to reduce salt intake in North Karelia from 1979 to 1982 confirmed that Na intake level is high in Finland. The North Karelia Salt Project showed that it is difficult to reduce salt intake at the community level during a three-year period. A slight reduction in Na intake was seen only in women both in North Karelia and in the reference area. In men Na intake did not decrease. In conclusion our results suggest that primary prevention of hypertension at the community level is not easy and that a well conceived programme for a relatively long time period is needed.

Community-based prevention of hypertension in North Karelia, Finland.

To test whether the cardiovascular disease declines in North Karelia were accompanied by subjective improvements in health, we analyzed responses to two questions about perceived risk of heart disease and health status on independent random population samples surveyed 10 years apart. Age stratified perceived risk of heart disease declined significantly more (p less than .01) and age stratified perceived health status improved significantly more in North Karelia than in the reference area (p less than .005).

Changes in perceived heart disease risk and health during a community-based heart disease prevention program: the North Karelia project.

A hypertension control program was established as part of the more comprehensive North Karelia Project. This project was started in 1972 in response to a petition from the population of North Karelia, a county in Finland, asking for national assistance to reduce the exceptionally high cardiovascular disease mortality and morbidity in the area. The North Karelia Project was carried out from 1972 to 1977.The hypertension control program was implemented mainly in local health centers by physicians and public health nurses, who followed guidelines issued by the project staff and worked under its supervision.Although the target population for the North Karelia Project was the entire population of North Karelia, the project focused on middle-aged men. The hypertension subprogram was introduced in steps. Its objectives included the training of health personnel, establishment of an information system in the county to educate people about hypertension, and organization of the detection, treatment, and followup of hypertensives. A hypertension dispensary was established in each of the 12 health centers in the county. Continuous training of the local public health nurses and physicians faciliated integration of the hypertension program into the operations of the health centers.A central hypertension register and the hypertension control clinics at the health centers were the essential tools in the systematic followup of hypertensives. Some 17,000 hypertensives were on the register by the end of the 5-year project.The main aim in providing health education about hypertension, as well as in treating hypertension itself, was to prevent severe cardiovascular diseases as a whole. Therefore the hypertension control program was integrated into the comprehensive cardiovascular disease control program, and hypertensives received advice concerning smoking and dietary changes as well as about high blood pressure.A survey of health care personnel in North Karelia and in a reference area showed that the care of hypertensives was more systematic in North Karelia and that its health care personnel were more satisfied with the cardiovascular disease care that was provided.

Implementation of a hypertension control program in the county of North Karelia, Finland.

The hypertension programme of the North Karelia Project aimed at lowering the high blood pressure level among the whole population The influence of socioeconomic factors on the effect of reorganized hypertension care was analyzed among a cohort of 222 hypertensive patients during the five year follow-up The fall in mean arterial pressure was significantly greater in North Karelia than in the reference area A slight but not significant difference was found in blood pressure reduction between high and low socioeconomical classes The results were better in higher socioeconomic groups, but the blood pressure reduction was clear also in lower socioeconomic groups Our results indicate that the systematic community-based hypertension control programme will result in favourable changes in blood pressure level in the entire population without any clear preference on particular socioeconomic subgroups

Salonen Jt

Papers

Intake of spirits and beer and risk of myocardial infarction and death - a longitudinal study

Community-based prevention of hypertension in North Karelia, Finland.

Changes in perceived heart disease risk and health during a community-based heart disease prevention program: the North Karelia project.

Implementation of a hypertension control program in the county of North Karelia, Finland.

The influence of socioeconomic factors on blood pressure control during a community-based hypertension control programme.