The persistent social patterning of cardiovascular risk: rethinking the familiar

Abstract

There is abundant evidence that cardiovascular disease is strongly patterned by socioeconomic position.1 Contrary to the stereotypical image of the wealthy but stressed executive who dies of a heart attack, people in the lowest socioeconomic strata, whether defined by income, education, or occupation, are consistently at greater risk of cardiovascular disease, at least in industrialized countries. Interestingly, the increased risk is not limited to the very poor but appears to decrease in quite a remarkable graded fashion, as socioeconomic resources increase.2,3 This graded relationship, which is observed for virtually all indicators of socioeconomic position, is striking given the crudeness with which social factors are usually measured in epidemiological and clinical studies, and the fact that these factors are necessarily very distal to the biological processes that lead to the development of atherosclerosis and the precipitation of clinical events. The strength and persistence of these patterns suggest a pervasive influence of social context on the body and on the cardiovascular system in particular. However, like many things that we are used to seeing over and over again, with time they become invisible and their significance is forgotten.