Abstract
Study objective: Systemic inflammation may play an important part in the development of cardiovascular disease. It has also been shown that socioeconomic status predicts cardiovascular events independently of established risk factors. The aim of this study was to analyse the association of three sensitive markers of systemic inflammation: C reactive protein (CRP), serum amyloid A protein (SAA), and fibrinogen, with socioeconomic status.
Design: Cross sectional study.
Setting: Eastern and southern Finland.
Participants: 1503 men aged 45 to 74 years who participated in a cardiovascular risk factor survey in 1997. Based on the levels of education and family income, the men were classified to three socioeconomic groups.
Main results: Mean concentrations of CRP (p for the trend <0.001), SAA (p for the trend 0.018), and fibrinogen (p for the trend <0.001) decreased substantially with increasing socioeconomic status. The trends in CRP and fibrinogen remained statistically significant after adjustment for smoking, waist to hip ratio, and prevalent longstanding diseases, and a non-significant trend was found for SAA (p for the trend 0.118). The inverse association between inflammation markers and socioeconomic status was particularly strong among the men below 60 years of age.
Conclusions: Systemic inflammation is a potential mediator, especially among young and middle aged men, for the association between socioeconomic status and cardiovascular disease.
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Selected References
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- Barker D. J., Gluckman P. D., Godfrey K. M., Harding J. E., Owens J. A., Robinson J. S. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993 Apr 10;341(8850):938–941. doi: 10.1016/0140-6736(93)91224-a. [DOI] [PubMed] [Google Scholar]
- Berk B. C., Weintraub W. S., Alexander R. W. Elevation of C-reactive protein in "active" coronary artery disease. Am J Cardiol. 1990 Jan 15;65(3):168–172. doi: 10.1016/0002-9149(90)90079-g. [DOI] [PubMed] [Google Scholar]
- CLAUSS A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol. 1957 Apr;17(4):237–246. doi: 10.1159/000205234. [DOI] [PubMed] [Google Scholar]
- Cohen M. C., Cohen S. Cytokine function: a study in biologic diversity. Am J Clin Pathol. 1996 May;105(5):589–598. doi: 10.1093/ajcp/105.5.589. [DOI] [PubMed] [Google Scholar]
- Danesh J., Collins R., Peto R. Chronic infections and coronary heart disease: is there a link? Lancet. 1997 Aug 9;350(9075):430–436. doi: 10.1016/S0140-6736(97)03079-1. [DOI] [PubMed] [Google Scholar]
- Danesh J., Muir J., Wong Y. K., Ward M., Gallimore J. R., Pepys M. B. Risk factors for coronary heart disease and acute-phase proteins. A population-based study. Eur Heart J. 1999 Jul;20(13):954–959. doi: 10.1053/euhj.1998.1309. [DOI] [PubMed] [Google Scholar]
- Ernst E., Resch K. L. Fibrinogen as a cardiovascular risk factor: a meta-analysis and review of the literature. Ann Intern Med. 1993 Jun 15;118(12):956–963. doi: 10.7326/0003-4819-118-12-199306150-00008. [DOI] [PubMed] [Google Scholar]
- Ernst E. The role of fibrinogen as a cardiovascular risk factor. Atherosclerosis. 1993 Apr;100(1):1–12. doi: 10.1016/0021-9150(93)90062-y. [DOI] [PubMed] [Google Scholar]
- Fyfe A. I., Rothenberg L. S., DeBeer F. C., Cantor R. M., Rotter J. I., Lusis A. J. Association between serum amyloid A proteins and coronary artery disease: evidence from two distinct arteriosclerotic processes. Circulation. 1997 Nov 4;96(9):2914–2919. doi: 10.1161/01.cir.96.9.2914. [DOI] [PubMed] [Google Scholar]
- Iso H., Shimamoto T., Sato S., Koike K., Iida M., Komachi Y. Passive smoking and plasma fibrinogen concentrations. Am J Epidemiol. 1996 Dec 15;144(12):1151–1154. doi: 10.1093/oxfordjournals.aje.a008893. [DOI] [PubMed] [Google Scholar]
- Jousilahti P., Salomaa V., Rasi V., Vahtera E., Palosuo T. The association of c-reactive protein, serum amyloid a and fibrinogen with prevalent coronary heart disease--baseline findings of the PAIS project. Atherosclerosis. 2001 Jun;156(2):451–456. doi: 10.1016/s0021-9150(00)00681-x. [DOI] [PubMed] [Google Scholar]
- Kannel W. B., Wolf P. A., Castelli W. P., D'Agostino R. B. Fibrinogen and risk of cardiovascular disease. The Framingham Study. JAMA. 1987 Sep 4;258(9):1183–1186. [PubMed] [Google Scholar]
- Koenig W., Sund M., Fröhlich M., Fischer H. G., Löwel H., Döring A., Hutchinson W. L., Pepys M. B. C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation. 1999 Jan 19;99(2):237–242. doi: 10.1161/01.cir.99.2.237. [DOI] [PubMed] [Google Scholar]
- Kovanen P. T., Mänttäri M., Palosuo T., Manninen V., Aho K. Prediction of myocardial infarction in dyslipidemic men by elevated levels of immunoglobulin classes A, E, and G, but not M. Arch Intern Med. 1998 Jul 13;158(13):1434–1439. doi: 10.1001/archinte.158.13.1434. [DOI] [PubMed] [Google Scholar]
- Kuller L. H., Tracy R. P., Shaten J., Meilahn E. N. Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Multiple Risk Factor Intervention Trial. Am J Epidemiol. 1996 Sep 15;144(6):537–547. doi: 10.1093/oxfordjournals.aje.a008963. [DOI] [PubMed] [Google Scholar]
- Kunst A. E., Mackenbach J. P. International variation in the size of mortality differences associated with occupational status. Int J Epidemiol. 1994 Aug;23(4):742–750. doi: 10.1093/ije/23.4.742. [DOI] [PubMed] [Google Scholar]
- Kunst A. E., Mackenbach J. P. The size of mortality differences associated with educational level in nine industrialized countries. Am J Public Health. 1994 Jun;84(6):932–937. doi: 10.2105/ajph.84.6.932. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lagrand W. K., Niessen H. W., Wolbink G. J., Jaspars L. H., Visser C. A., Verheugt F. W., Meijer C. J., Hack C. E. C-reactive protein colocalizes with complement in human hearts during acute myocardial infarction. Circulation. 1997 Jan 7;95(1):97–103. doi: 10.1161/01.cir.95.1.97. [DOI] [PubMed] [Google Scholar]
- Lagrand W. K., Visser C. A., Hermens W. T., Niessen H. W., Verheugt F. W., Wolbink G. J., Hack C. E. C-reactive protein as a cardiovascular risk factor: more than an epiphenomenon? Circulation. 1999 Jul 6;100(1):96–102. doi: 10.1161/01.cir.100.1.96. [DOI] [PubMed] [Google Scholar]
- Libby P., Hansson G. K. Involvement of the immune system in human atherogenesis: current knowledge and unanswered questions. Lab Invest. 1991 Jan;64(1):5–15. [PubMed] [Google Scholar]
- Malle E., Steinmetz A., Raynes J. G. Serum amyloid A (SAA): an acute phase protein and apolipoprotein. Atherosclerosis. 1993 Sep;102(2):131–146. doi: 10.1016/0021-9150(93)90155-n. [DOI] [PubMed] [Google Scholar]
- Martyn C. N., Meade T. W., Stirling Y., Barker D. J. Plasma concentrations of fibrinogen and factor VII in adult life and their relation to intra-uterine growth. Br J Haematol. 1995 Jan;89(1):142–146. doi: 10.1111/j.1365-2141.1995.tb08920.x. [DOI] [PubMed] [Google Scholar]
- Mattila K. J., Nieminen M. S., Valtonen V. V., Rasi V. P., Kesäniemi Y. A., Syrjälä S. L., Jungell P. S., Isoluoma M., Hietaniemi K., Jokinen M. J. Association between dental health and acute myocardial infarction. BMJ. 1989 Mar 25;298(6676):779–781. doi: 10.1136/bmj.298.6676.779. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McDonald K., Rector T. S., Braulin E. A., Kubo S. H., Olivari M. T. Association of coronary artery disease in cardiac transplant recipients with cytomegalovirus infection. Am J Cardiol. 1989 Aug 1;64(5):359–362. doi: 10.1016/0002-9149(89)90535-3. [DOI] [PubMed] [Google Scholar]
- Mendall M. A., Patel P., Asante M., Ballam L., Morris J., Strachan D. P., Camm A. J., Northfield T. C. Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease. Heart. 1997 Sep;78(3):273–277. doi: 10.1136/hrt.78.3.273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mendall M. A., Patel P., Ballam L., Strachan D., Northfield T. C. C reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study. BMJ. 1996 Apr 27;312(7038):1061–1065. doi: 10.1136/bmj.312.7038.1061. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nieminen M. S., Mattila K., Valtonen V. Infection and inflammation as risk factors for myocardial infarction. Eur Heart J. 1993 Dec;14 (Suppl K):12–16. [PubMed] [Google Scholar]
- Nieto F. J., Sorlie P., Comstock G. W., Wu K., Adam E., Melnick J. L., Szklo M. Cytomegalovirus infection, lipoprotein(a), and hypercoagulability: an atherogenic link? Arterioscler Thromb Vasc Biol. 1997 Sep;17(9):1780–1785. doi: 10.1161/01.atv.17.9.1780. [DOI] [PubMed] [Google Scholar]
- Patel P., Mendall M. A., Carrington D., Strachan D. P., Leatham E., Molineaux N., Levy J., Blakeston C., Seymour C. A., Camm A. J. Association of Helicobacter pylori and Chlamydia pneumoniae infections with coronary heart disease and cardiovascular risk factors. BMJ. 1995 Sep 16;311(7007):711–714. doi: 10.1136/bmj.311.7007.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pekkanen J., Tuomilehto J., Uutela A., Vartiainen E., Nissinen A. Social class, health behaviour, and mortality among men and women in eastern Finland. BMJ. 1995 Sep 2;311(7005):589–593. doi: 10.1136/bmj.311.7005.589. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ridker P. M., Glynn R. J., Hennekens C. H. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation. 1998 May 26;97(20):2007–2011. doi: 10.1161/01.cir.97.20.2007. [DOI] [PubMed] [Google Scholar]
- Ridker P. M., Hennekens C. H., Buring J. E., Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000 Mar 23;342(12):836–843. doi: 10.1056/NEJM200003233421202. [DOI] [PubMed] [Google Scholar]
- Rimm E. B., Stampfer M. J., Giovannucci E., Ascherio A., Spiegelman D., Colditz G. A., Willett W. C. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol. 1995 Jun 15;141(12):1117–1127. doi: 10.1093/oxfordjournals.aje.a117385. [DOI] [PubMed] [Google Scholar]
- Roivainen M., Alfthan G., Jousilahti P., Kimpimäki M., Hovi T., Tuomilehto J. Enterovirus infections as a possible risk factor for myocardial infarction. Circulation. 1998 Dec 8;98(23):2534–2537. doi: 10.1161/01.cir.98.23.2534. [DOI] [PubMed] [Google Scholar]
- Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999 Jan 14;340(2):115–126. doi: 10.1056/NEJM199901143400207. [DOI] [PubMed] [Google Scholar]
- Saikku P., Leinonen M., Mattila K., Ekman M. R., Nieminen M. S., Mäkelä P. H., Huttunen J. K., Valtonen V. Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet. 1988 Oct 29;2(8618):983–986. doi: 10.1016/s0140-6736(88)90741-6. [DOI] [PubMed] [Google Scholar]
- Thompson S. G., Kienast J., Pyke S. D., Haverkate F., van de Loo J. C. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. N Engl J Med. 1995 Mar 9;332(10):635–641. doi: 10.1056/NEJM199503093321003. [DOI] [PubMed] [Google Scholar]
- Tracy R. P. Inflammation in cardiovascular disease: cart, horse, or both? Circulation. 1998 May 26;97(20):2000–2002. doi: 10.1161/01.cir.97.20.2000. [DOI] [PubMed] [Google Scholar]
- Tracy R. P., Lemaitre R. N., Psaty B. M., Ives D. G., Evans R. W., Cushman M., Meilahn E. N., Kuller L. H. Relationship of C-reactive protein to risk of cardiovascular disease in the elderly. Results from the Cardiovascular Health Study and the Rural Health Promotion Project. Arterioscler Thromb Vasc Biol. 1997 Jun;17(6):1121–1127. doi: 10.1161/01.atv.17.6.1121. [DOI] [PubMed] [Google Scholar]
- Valkonen T. Trends in regional and socio-economic mortality differentials in Finland. Int J Health Sci. 1992;3(3-4):157–166. [PubMed] [Google Scholar]
- Wilson T. W., Kaplan G. A., Kauhanen J., Cohen R. D., Wu M., Salonen R., Salonen J. T. Association between plasma fibrinogen concentration and five socioeconomic indices in the Kuopio Ischemic Heart Disease Risk Factor Study. Am J Epidemiol. 1993 Feb 1;137(3):292–300. doi: 10.1093/oxfordjournals.aje.a116676. [DOI] [PubMed] [Google Scholar]
- Yudkin J. S., Stehouwer C. D., Emeis J. J., Coppack S. W. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol. 1999 Apr;19(4):972–978. doi: 10.1161/01.atv.19.4.972. [DOI] [PubMed] [Google Scholar]