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The impact of socioeconomic status on the burden of atherosclerosis, and the effect of intensive preventive therapy on its progression: A retrospective cohort study

  • Author Footnotes
    1 These authors contributed equally to this work.
    Amadene B. Woolsey
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada

    Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Shahram Arsang-Jang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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  • J. David Spence
    Affiliations
    Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada

    Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
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  • Daniel G. Hackam
    Affiliations
    Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada
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  • M. Reza Azarpazhooh
    Correspondence
    Corresponding author. Stroke Prevention and Atherosclerosis Research Centre, 1400 Western Road, London, Ontario, Canada.
    Affiliations
    Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada

    Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada

    Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      Highlights

      • Social deprivation is associated with cardiovascular disease.
      • Social deprivation has a strong association with atherosclerosis and should be considered an important risk factor.
      • Intensive preventive therapy can prevent plaque progression irrespective of baseline marginalization index.

      Abstract

      Background and aims

      Socioeconomic status (SES) is associated with cardiovascular disease. However, the relationship between SES and atherosclerosis is not well documented. This study aims to explore this relationship.

      Methods

      This is a retrospective cohort study in London, Ontario Canada. It includes 6,907 subjects from a vascular prevention centre at baseline, with long term follow up from 1989 to 2021 (total ultrasound examinations 27,103). Using carotid ultrasound, the burden of atherosclerosis was measured as total plaque area (TPA). The Ontario Marginalization Index (OMI) was used to identify SES of participants' neighborhoods. We used a Bayesian hierarchical regression and mixed effects model to identify associations between SES, baseline TPA and plaque progression. In 2003, we implemented more intensive therapy of vascular risk factors after 2003 (called “Treating arteries instead of risk treating factors”); therefore, we compared our findings before and after 2003.

      Results

      SES was found to have a significant association with TPA, with lower SES associated with higher TPA (adjusted odds ratio [OR] = 2.22, 95% Credible interval [CrI]: 1.37, 3.66). While we observed a higher rate of plaque progression with lower SES in those treated before 2003 (OR = 1.46, 95% CrI:1.04, 2.06), there was no significant association between plaque progression and SES after implementation more intensive therapy (OR = 0.99, 95% CrI: 0.78, 1.27).

      Conclusions

      SES has a strong association with atherosclerosis and should be considered an important risk factor in clinical practice and vascular disease research. Intensive preventive therapy can prevent plaque progression irrespective of baseline SES.

      Graphical abstract

      Keywords

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