Psychosocial stressors may mediate the effect of social status on the metabolic syndrome (MS). The paper explores this hypothesis in a random sample of the general population.
Design
A total of 3462 women and 2576 men aged 20-97 years from the Copenhagen City Heart Study.
Methods
An MS index was defined from the seven components: waist-hip ratio, high-density lipoprotein (HDL-cholesterol, triglycerides, systolic blood pressure (SBP), blood glucose, C-reactive protein (CRP) and fibrinogen. Social status was measured by educational level. Psychosocial factors included fatigue and depression, perceived stress, social network and cohabitation. Behavioural factors were smoking, alcohol and physical activity.
Results
There was an inverse social gradient in the prevalence of the seven components of the MS. The age-adjusted odds ratio (OR) (95% confidence interval) for occupying the most disadvantaged quintile, comparing highest with lowest educational level, were for men and women, respectively: waist-hip ratio 0.48 (0.34-0.69) and 0.48 (0.33-0.69); HDL-cholesterol 0.61 (0.45-0.84) and 0.46 (0.33-0.64); triglycerides 0.71 (0.51-0.98) and 0.37 (0.25-0.53); SBP 0.64 (0.44-0.92) and 0.76 (0.50-1.15); blood glucose 0.57 (0.41-0.80) and 0.55 (0.38-0.78); CRP 0.53 (0.37-0.74) and 0.44 (0.31-0.63), and fibrinogen 0.50 (0.35-0.70) and 0.56 (0.38-0.82). The pooled OR for having an MS index score of 3 or more was 0.32 (0.24-0.42) for highest versus lowest educational level. A higher fatigue and depression score in both sexes and a lack of social support in men were associated with the MS, as were smoking, low alcohol consumption and a lack of physical activity. However, OR for educational level were not affected by adjustment for the psychosocial or behavioural factors.
Conclusions
There is a strong inverse social gradient in the prevalence of the MS, which is not explained by psychosocial or major behavioural factors.
AndersenIOslerMPetersenLGronbaekMPrescottE.Income and risk of ischaemic heart disease in men and women in a Nordic welfare country. Int J Epidemiol2003; 2:367–374.
2.
van RossumCTShipleyMJVan de MheenHGrobbeeDEMarmotMG.Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall Study. J Epidemiol Commun Health2000; 54:178–184.
3.
DalstraJAKunstAEBorrellCBreezeECamboisECostaG. Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol2005; 34:316–326.
4.
KaplanGAKeilJE.Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation1993; 88:1973–1998.
5.
GonzalezMARodriguezAFCaleroJR.Relationship between socioeconomic status and ischaemic heart disease in cohort and case-control studies: 1960-1993. Int J Epidemiol1998; 27:350–358.
6.
RozanskiABlumenthalJADavidsonKWSaabPGKubzanskyL.The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol2005; 45:637–651.
7.
SteptoeAMarmotM.The role of psychobiological pathways in socioeconomic inequalities in cardiovascular disease risk. Eur Heart J2002; 23:13–25.
8.
BrunnerEJMarmotMGNanchahalKShipleyMJStansfeldSAJunejaMAlbertiKG.Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II Study. Diabetologia1997; 40:1341–1349.
9.
HemingwayHShipleyMBrunnerEBrittonAMalikMMarmotM.Does autonomic function link social position to coronary risk? The Whitehall II Study. Circulation2005; 111:3071–3077.
10.
ChandolaTBrunnerEMarmotM.Chronic stress at work and the metabolic syndrome: prospective study. BMJ2006; 332:521–525.
11.
PrescottEHolstCGronbaekMSchnohrPJensenGBarefootJ.Vital exhaustion as a risk factor for ischaemic heart disease and all-cause mortality in a community sample. A prospective study of 4084 men and 5479 women in the Copenhagen City Heart Study. Int J Epidemiol2003; 32:990–997.
12.
BarefootJCGronbaekMJensenGSchnohrPPrescottE.Social network diversity and risks of ischemic heart disease and total mortality: findings from the Copenhagen City Heart Study. Am J Epidemiol2005; 161:960–967.
13.
AppelsAMulderP.Fatigue and heart disease. The association between‘vital exhaustion’ and past, present and future coronary heart disease. J Psychosom Res1989; 33:727–738.
14.
RosengrenAHawkenSOunpuuSSliwaKZubaidMAlmahmeedWA. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART Study): case-control study. Lancet2004; 364:953–962.
15.
Third Report of the National Cholesterol Education Program (NCEP).Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final report. Circulation2002; 106:3143–3421.
16.
GrundySMBrewerHBJrCleemanJISmithSCJrLenfantC.Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/ American Heart Association Conference on Scientific Issues Related to Definition. Circulation2004; 109:433–438.
17.
SmithGDShipleyMJRoseG.Magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall Study. J Epidemiol Commun Health1990; 44:265–270.
18.
LantzPMHouseJSLepkowskiJMWilliamsDRMeroRPChenJ.Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA1998; 279:1703–1708.
19.
LaaksonenMSarlio-LahteenkorvaSLahelmaE.Multiple dimensions of socioeconomic position and obesity among employees: the Helsinki Health Study. Obesity Res2004; 12:1851–1858.
20.
PowerCGrahamHDuePHallqvistJJoungIKuhDLynchJ.The contribution of childhood and adult socioeconomic position to adult obesity and smoking behaviour: an international comparison. Int J Epidemiol2005; 34:335–344.
21.
KumariMHeadJMarmotM.Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II Study. Arch Intern Med2004; 164:1873–1880.
22.
JousilahtiPSalomaaVRasiVVahteraEPalosuoT.Association of markers of systemic inflammation, C reactive protein, serum amyloid A, and fibrinogen, with socioeconomic status. J Epidemiol Commun Health2003; 57:730–733.
23.
BrunnerEJMarmotMGWhiteIRO'BrienJREtheringtonMDSlavinBM. Gender and employment grade differences in blood cholesterol, apolipoproteins and haemostatic factors in the Whitehall II Study. Atherosclerosis1993; 102:195–207.
24.
BrunnerEDaveySGMarmotMCannerRBeksinskaMO'BrienJChildhood social circumstances and psychosocial and behavioural factors as determinants of plasma fibrinogen. Lancet1996; 347:1008–1013.
25.
WamalaSPWolkASchenck-GustafssonKOrth-GomerK.Lipid profile and socioeconomic status in healthy middle aged women in Sweden. J Epidemiol Commun Health1997; 51:400–407.
26.
HemingwayHShipleyMMullenMJKumariMBrunnerETaylorM. Social and psychosocial influences on inflammatory markers and vascular function in civil servants (the Whitehall II Study). Am J Cardiol2003; 92:984–987.
27.
BrunnerEJHemingwayHWalkerBRPageMClarkePJunejaM. Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome: nested case-control study. Circulation2002; 106:2659–2665.
28.
WamalaSPWolkAOrth-GomerK.Determinants of obesity in relation to socioeconomic status among middle-aged Swedish women. Prev Med1997; 26:734–744.
29.
WamalaSPLynchJHorstenMMittlemanMASchenck-GustafssonKOrth-GomerK.Education and the metabolic syndrome in women. Diabetes Care1999; 22:1999–2003.
30.
WamalaSPMurrayMAHorstenMErikssonMSchenck-GustafssonKHamstenA. Socioeconomic status and determinants of hemostatic function in healthy women. Arterioscler Thromb Vasc Biol1999; 19:485–492.
31.
MensahGAMokdadAHFordESGreenlundKJCroftJB.State of disparities in cardiovascular health in the United States. Circulation2005; 111:1233–1241.
32.
ColhounHMHemingwayHPoulterNR.Socio-economic status and blood pressure: an overview analysis. J Hum Hypertens1998; 12:91–110.
33.
KuperHMarmotMHemingwayH.Systematic review of prospective cohort studies of psychosocial factors in the aetiology and prognosis of coronary heart disease. Semin Vasc Med2002; 2:267–314.
34.
BunkerSJColquhounDMEslerMDHickieIBHuntDJelinekVM. “Stress” and coronary heart disease: psychosocial risk factors. Med J Aust2003; 178:272–276.
35.
RosengrenATibblinGWilhelmsenL.Self-perceived psychological stress and incidence of coronary artery disease in middle-aged men. Am J Cardiol1991; 68:1171–1175.
36.
RuguliesR.Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med2002; 23:51–61.
37.
BrummettBHMarkDBSieglerICWilliamsRBBabyakMAClapp-ChanningNEBarefootJC.Perceived social support as a predictor of mortality in coronary patients: effects of smoking, sedentary behavior, and depressive symptoms. Psychosom Med2005; 67:40–45.
38.
FolkowB.Physiological aspects of the “defence” and “defeat” reactions. Acta Physiol Scand Suppl1997; 640:34–37.
39.
RosmondRBjorntorpP.Occupational status, cortisol secretory pattern, and visceral obesity in middle-aged men. Obesity Res2000; 8:445–450.
40.
JahnHSchickMKieferFKellnerMYassouridisAWiedemannK.Metyrapone as additive treatment in major depression: a double-blind and placebo-controlled trial. Arch Gen Psychiatry2004; 61:1235–1244.
41.
GalloLCMatthewsKA.Understanding the association between socioeconomic status and physical health: do negative emotions play a role? Psychol Bull2003; 129:10–51.
42.
LynchJWKaplanGACohenRDTuomilehtoJSalonenJT.Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol1996; 144:934–942.
43.
SmithGDBenShlomo YBeswickAYarnellJLightmanSElwoodP.Cortisol, testosterone, and coronary heart disease: prospective evidence from the Caerphilly Study. Circulation2005; 112:332–340.
44.
KoskenvuoMKaprioJLonnqvistJSarnaS.Social factors and the gender difference in mortality. Soc Sci Med1986; 23:605–609.
45.
ShumakerSAHillDR.Gender differences in social support and physical health. Health Psychol1991; 10:102–111.
46.
RaikkonenKHautanenAKeltikangas-JarvinenL.Association of stress and depression with regional fat distribution in healthy middle-aged men. J Behav Med1994; 17:605–616.
MaesM.Major depression and activation of the inflammatory response system. Adv Exp Med Biol1999; 461:25–46.
49.
KopWJGottdienerJSTangenCMFriedLPMcBurnieMAWalstonJ. Inflammation and coagulation factors in persons 65 years of age with symptoms of depression but without evidence of myocardial ischemia. Am J Cardiol2002; 89:419–424.
50.
Orth-GomerKRosengrenAWilhelmsenL.Lack of social support and incidence of coronary heart disease in middle-aged Swedish men. Psychosom Med1993; 55:37–43.
51.
RaikkonenKMatthewsKAKullerLH.The relationship between psychological risk attributes and the metabolic syndrome in healthy women: antecedent or consequence? Metabolism2002; 51:1573–1577.
52.
AndersenLBVestboJJuelKBjergAMKeidingNJensenG. A comparison of mortality rates in three prospective studies from Copenhagen with mortality rates in the central part of the city, and the entire country. Eur J Epidemiol1998; 14:579–585.
