Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?

<p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score vari...
Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Tancredi Daniel J [verfasserIn] Winters Paul C [verfasserIn] Franks Peter [verfasserIn] Fiscella Kevin A [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2011

Schlagwörter:	coronary disease cholesterol epidemiology prevention risk factors

Übergeordnetes Werk:	In: BMC Cardiovascular Disorders - BMC, 2003, 11(2011), 1, p 28
Übergeordnetes Werk:	volume:11 ; year:2011 ; number:1, p 28

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1186/1471-2261-11-28

Katalog-ID:	DOAJ065198409

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520			\|a <p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p<
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allfields	10.1186/1471-2261-11-28 doi (DE-627)DOAJ065198409 (DE-599)DOAJ72046af484994fd4b181d6bec6bf4e65 DE-627 ger DE-627 rakwb eng RC666-701 Tancredi Daniel J verfasserin aut Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p< coronary disease cholesterol epidemiology prevention risk factors Diseases of the circulatory (Cardiovascular) system Winters Paul C verfasserin aut Franks Peter verfasserin aut Fiscella Kevin A verfasserin aut In BMC Cardiovascular Disorders BMC, 2003 11(2011), 1, p 28 (DE-627)335488870 (DE-600)2059859-2 14712261 nnns volume:11 year:2011 number:1, p 28 https://doi.org/10.1186/1471-2261-11-28 kostenfrei https://doaj.org/article/72046af484994fd4b181d6bec6bf4e65 kostenfrei http://www.biomedcentral.com/1471-2261/11/28 kostenfrei https://doaj.org/toc/1471-2261 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 11 2011 1, p 28
spelling	10.1186/1471-2261-11-28 doi (DE-627)DOAJ065198409 (DE-599)DOAJ72046af484994fd4b181d6bec6bf4e65 DE-627 ger DE-627 rakwb eng RC666-701 Tancredi Daniel J verfasserin aut Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p< coronary disease cholesterol epidemiology prevention risk factors Diseases of the circulatory (Cardiovascular) system Winters Paul C verfasserin aut Franks Peter verfasserin aut Fiscella Kevin A verfasserin aut In BMC Cardiovascular Disorders BMC, 2003 11(2011), 1, p 28 (DE-627)335488870 (DE-600)2059859-2 14712261 nnns volume:11 year:2011 number:1, p 28 https://doi.org/10.1186/1471-2261-11-28 kostenfrei https://doaj.org/article/72046af484994fd4b181d6bec6bf4e65 kostenfrei http://www.biomedcentral.com/1471-2261/11/28 kostenfrei https://doaj.org/toc/1471-2261 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 11 2011 1, p 28
allfields_unstemmed	10.1186/1471-2261-11-28 doi (DE-627)DOAJ065198409 (DE-599)DOAJ72046af484994fd4b181d6bec6bf4e65 DE-627 ger DE-627 rakwb eng RC666-701 Tancredi Daniel J verfasserin aut Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p< coronary disease cholesterol epidemiology prevention risk factors Diseases of the circulatory (Cardiovascular) system Winters Paul C verfasserin aut Franks Peter verfasserin aut Fiscella Kevin A verfasserin aut In BMC Cardiovascular Disorders BMC, 2003 11(2011), 1, p 28 (DE-627)335488870 (DE-600)2059859-2 14712261 nnns volume:11 year:2011 number:1, p 28 https://doi.org/10.1186/1471-2261-11-28 kostenfrei https://doaj.org/article/72046af484994fd4b181d6bec6bf4e65 kostenfrei http://www.biomedcentral.com/1471-2261/11/28 kostenfrei https://doaj.org/toc/1471-2261 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 11 2011 1, p 28
allfieldsGer	10.1186/1471-2261-11-28 doi (DE-627)DOAJ065198409 (DE-599)DOAJ72046af484994fd4b181d6bec6bf4e65 DE-627 ger DE-627 rakwb eng RC666-701 Tancredi Daniel J verfasserin aut Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p< coronary disease cholesterol epidemiology prevention risk factors Diseases of the circulatory (Cardiovascular) system Winters Paul C verfasserin aut Franks Peter verfasserin aut Fiscella Kevin A verfasserin aut In BMC Cardiovascular Disorders BMC, 2003 11(2011), 1, p 28 (DE-627)335488870 (DE-600)2059859-2 14712261 nnns volume:11 year:2011 number:1, p 28 https://doi.org/10.1186/1471-2261-11-28 kostenfrei https://doaj.org/article/72046af484994fd4b181d6bec6bf4e65 kostenfrei http://www.biomedcentral.com/1471-2261/11/28 kostenfrei https://doaj.org/toc/1471-2261 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 11 2011 1, p 28
allfieldsSound	10.1186/1471-2261-11-28 doi (DE-627)DOAJ065198409 (DE-599)DOAJ72046af484994fd4b181d6bec6bf4e65 DE-627 ger DE-627 rakwb eng RC666-701 Tancredi Daniel J verfasserin aut Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p< coronary disease cholesterol epidemiology prevention risk factors Diseases of the circulatory (Cardiovascular) system Winters Paul C verfasserin aut Franks Peter verfasserin aut Fiscella Kevin A verfasserin aut In BMC Cardiovascular Disorders BMC, 2003 11(2011), 1, p 28 (DE-627)335488870 (DE-600)2059859-2 14712261 nnns volume:11 year:2011 number:1, p 28 https://doi.org/10.1186/1471-2261-11-28 kostenfrei https://doaj.org/article/72046af484994fd4b181d6bec6bf4e65 kostenfrei http://www.biomedcentral.com/1471-2261/11/28 kostenfrei https://doaj.org/toc/1471-2261 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 11 2011 1, p 28
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However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. 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callnumber-first	R - Medicine
author	Tancredi Daniel J
spellingShingle	Tancredi Daniel J misc RC666-701 misc coronary disease misc cholesterol misc epidemiology misc prevention misc risk factors misc Diseases of the circulatory (Cardiovascular) system Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?
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topic_title	RC666-701 Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease? coronary disease cholesterol epidemiology prevention risk factors
topic	misc RC666-701 misc coronary disease misc cholesterol misc epidemiology misc prevention misc risk factors misc Diseases of the circulatory (Cardiovascular) system
topic_unstemmed	misc RC666-701 misc coronary disease misc cholesterol misc epidemiology misc prevention misc risk factors misc Diseases of the circulatory (Cardiovascular) system
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title	Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?
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author_browse	Tancredi Daniel J Winters Paul C Franks Peter Fiscella Kevin A
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title_sort	do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?
callnumber	RC666-701
title_auth	Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?
abstract	<p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p<
abstractGer	<p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p<
abstract_unstemmed	<p<Abstract</p< <p<Background</p< <p<Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it<changes </it<in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p< <p<Methods</p< <p<The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p<
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title_short	Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?
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Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p< <p<Results</p< <p<Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p< <p<Conclusion</p< <p<Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. 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Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?

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