Impact of psychological and social factors on cardiovascular risk in an adult population at high cardiovascular risk

Abstract

Background: Cardiovascular diseases (CVDs) remain the leading cause of morbimortality and disability in the world. Although Spain has one of the lowest cardiovascular morbimortality rates worldwide, CVDs continue to be the main cause of death. In addition the prevalence of classic cardiovascular risk factors such as hypertension, diabetes, dyslipidaemia and obesity in the general population is high. Causes leading to cardiovascular diseases are multifactorial and several modifiable and non-modifiable risk factors are involved. In the last three decades, the scientific evidence has shown that socioeconomic and psychological disadvantaged conditions at individual and ecological levels are directly and indirectly related with prevalence of unhealthy lifestyles, poor cardiovascular profile, and incidence and worsening progression of CVDs. However, the mechanisms or pathways through which these conditions lead to adverse cardiovascular outcomes are not completely clear. In Spain, the role of those circumstances in the cardiovascular risk has been scarcely studied. General Objective: The present thesis is aimed at studying the role of socioeconomic position, depression and social support on three topics of the cardiovascular risk.: (1) the treatment received in primary cardiovascular prevention; (2) the degree of control and the values of blood pressure; and (3) the increased risk of suffering primary major cardiovascular events (acute myocardial infarction, stroke and cardiovascular death) in an adult population with high cardiovascular risk (PREDIMED study participants), living in Spain. Methods: This thesis is composed of three research studies carried out on 7447 adults at high cardiovascular risk, free of CVDs at baseline. A cross-sectional study was carried out to assess (1) the relationship between the socioeconomic status and inequalities in receiving treatment for primary cardiovascular prevention; and (2) to assess the effect of treated and untreated depression on blood pressure values. A prospective cohort study (average follow up of 4.8 years) was performed to determine whether depression, lower educational level and weak social support contributed to increase the risk of suffering myocardial infarction, stroke, and death from CVDs. Other characteristics such as sex, age, BMI, cardiovascular comorbidity, lifestyles at study baseline, were also taken into account in the studies performed. Results: Regarding the impact of the psychological and socioeconomic factors on the three aspects of cardiovascular risk studied, it was found: (1) participants with low and middle education level were similarly treated for hypertension (OR (95% CI): middle education level (MEL): 0.75 (0.56-1.00), low educational level (LEL): 0.85 (0.65-1.10); diabetes (MEL: 0.86 (0.61-1.22), LEL: (0.90 (0.67-1.22), and dyslipidaemia (MEL: 0.93 (0.75-1.15), LEL: 0.99 (0.82-1.19) if compared with those at high education level; (2) hypertensive participants with not treatment (OR (95% CI): 1.28 (1.06-1.55), and treatment (OR (95% CI): 1.30 (1.03-1.65) for depression shown better blood pressure control than those without depression; (3) Participant with low education presented higher risk of suffering stroke (HR (95% CI): 1.83 (1.09–3.09) ) compared with those with high education. Conclusions: in the studied population, (1) socioeconomic differences did not affect the treatment prescribed for primary cardiovascular prevention; (2) among hypertensive patients at high cardiovascular risk, the control of blood pressure was better in those diagnosed with depression compared to those without depression; and (3) participants with low educational level had a higher risk of stroke. Depression and low social support were not associated with CVD incidence.

Date of Award	28 Apr 2015
Original language	English
Supervisor	Miguel Angel Muñoz Perez (Director)