Cardiovascular disease is associated with a low social class position in numerous epidemiological studies. The mechanisms behind this finding are not fully known, although several factors may be of importance (e.g. lifestyle, neuroendocrine regulation, foetal deprivation). A better understanding of the biological basis for class-related disease may facilitate efforts in preventive medicine related to cardiovascular health.
1. Inequalities in health: report of a research working group. London, England: Department of Health and Social Security; 1980.
2.
2. Davey Smith G, Barley M, Blane D.The Black report on socioeconomic inequalities in health 10 years on. BMJ1990; 301: 373–7.
3.
3. Rosengren A.Wedel H, Wilhelmsen L.Coronary heart disease and mortality in middle-aged men from different occupational classes in Sweden. BMJ1988; 297: 1497–1500.
4.
4. Marmot MG, Rose G, Shipley M, Hamilton PJS.Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health1978; 32: 244–9.
5.
5. Pocock SJ, Shaper AG, Cook DG, Phillips AN, Walker M.Social class differences in ischaemic heart disease in British men. Lancet1987; II: 197–201.
6.
6. Marmot MG, McDowall M.Mortality decline and widening social inequalities. Lancet1986; II: 274–6.
7.
7. Eames M, Ben-Shlomo Y, Marmot MG.Social deprivation and premature mortality: regional comparision across England. BMJ1993; 307: 1097–1102.
8.
8. Rogot E, Sorlie PD, Johnson NJ, et alA mortality study of one million persons by demographic, social and economic factors: 1976–81 follow-up. Washington, DC: National Institute of Health; 1988. US Dept of Health, Education, and Welfare publication NIH 88–2896.
9.
9. Folkhälsorapport (Public health report) 1987, 1991 and 1994. Socialstyrelsen (National Board of Health and Welfare). Stockholm1987, 1991 and 1994.
10.
10. Barker DJP, Robinson RJ, eds. Fetal and infant origins of adult disease. First edition. London: British Medical Journal, 1992.
11.
11. Forsdahl A.Are poor living conditions in childhood and adolescence an important risk factor for arteriosclerotic heart disease?Br J Prev Soc Med1977; 31: 91–5.
12.
12. Karasek R, Theorell T.Healthy work. Stress, productivity, and the reconstruction of working life. New York, Basic Books, 1990.
13.
13. Henry J, Grim CE.Psychosocial mechanisms in primary hypertension. J Hypertens1990; 8: 783–93.
14.
14. Karasek R.Job demands, job decision latitude, and mental strain: implications for job redesign. Admin Sci Q1979; 24: 285–307.
15.
15. Steptoe A, Fieldman G, Evans O, Perry L.Control over work pace, job strain and cardiovascular responses in middle-aged men. J Hypertens1993; 11: 751–9.
16.
16. Alfredsson L, Karasek R, Theorell T.Myocardial infarction risk and psychosocial work environment: an analysis of the male Swedish working force, Soc Sci Med1982; 16: 463–7.
17.
17. Syme SL, Berkman LF.Social class, susceptibility and sickness. Am J Epidemiol1976; 104: 1–8.
18.
18. Hanson B, Ostergren PO.Different social network and social support characteristics, nervous problems and insomnia: theoretical and methodological aspects on some results from the population study “Men born in 1914,” Malmö, Sweden. Soc Sci Med1987; 25: 849–59.
19.
19. Marmot MG, Davey Smith G, Stansfield S, et alHealth inequalities among British civil servants: the Whitehall II study. Lancet1991; 337: 1387–93.
20.
20. Knutsson A.Shift work and coronary heart disease: Serum lipoproteins in day and shift workers: a prospective study (thesis). Scand J Soc Med1989; Suppl 44.
21.
21. Moser KA, Goldblatt PO, Fox AJ, Jones DRUnemployment and mortality: comparision of the 1971 and 1981 longitudinal study census sample. BMJ1987; 294: 86–90.
22.
22. Cassel J, Cobb S.Blood pressure changes in men undergoing job loss: A preliminary report. Psychosom Med1970; 32: 18–38.
23.
23. Mattiasson I, Lindgäde F, Nilsson JA, Theorell T.Threat of unemployment and cardiovascular risk factors: longitudinal study of quality of sleep and serum cholesterol concentrations in men threatened with redundancy. BMJ1990; 301: 461–6.
24.
24. Reaven GM.Role of insulin resistance in human disease. Diabetes1988; 37: 1595–607.
25.
25. Modan M, Halkin H, Almog S, et al.Hyperinsulinemia: a link between hypertension, obesity and glucose intolerance. J Clin Invest1985; 75: 809–17.
26.
26. Nilsson P, Lindholm L, Scherstén B.Hyperinsulinemia and other metabolic disturbances in well-controlled hypertensive men and women: an epidemiological study of the Dalby population. J Hypertens1990; 8: 953–9.
27.
27. Jarrett J.In defence of insulin: a critique of Syndrome X. Lancet1992; 340: 469–71.
28.
28. Pinkney JH, Nagi DK, Yudkin JS.From “Syndrome X” to the thrifty phenotype: a reappraisal of the insulin resistance theory of atherogenesis. Vasc Med Rev1993; 4: 19–47.
29.
29. Chrousos GP, Gold PW.The concept of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA1992; 267: 1244–52.
30.
30. Brindley DN, Rolland Y.Possible connections between stress, diabetes, obesity, hypertension and altered lipoprotein metabolism that may result in atherosclerosis. Clin Sci1989; 77: 453–61.
31.
31. Hautanen A, Adlercreutz H.Altered adrenocorticotropin and cortisol secretion in abdominal obesity: implications for the insulin resistance syndrome. J Internal Med1993; 234: 461–9.
32.
32. Theorell T, Karasek RA, Eneroth P.Job strain variation in relation to plasma testosterone fluctuations in working men-a longitudinal study. J Internal Med1990; 227: 31–6.
33.
33. Nilsson P, Møller L, Solstad K. Adverse effects of psychosocial stress on gonadal function and insulin-an epidemiological study in midle-aged men. 1994 (submitted).
34.
34. Björntorp P.Visceral fat accumulation: the missing link between psychosocial factors and cardiovascular disease?J Intemal Med1991; 230: 195–201.
35.
35. Møller L, Kristensen TS, Hollnagel H.Social class and cardiovascular risk factors in Danish men. Scand J Soc Med1991; 19: 116–26.
36.
36. Rosengren A, Wilhemsen L, Welin L, Tsipogianni A, Teger-Nilsson AC, Wedel H.Social influences and cardiovascular risk factors as determinants of plasma fibrinogen concentration in a general population sample of middle aged men. BMJ1990; 300: 634–8.
37.
37. Markowe HLJ, Marmot MG, Shipley MJ, et al. Fibrinogen: A possible link between social class and coronary heart disease. BMJ1985; 291: 1312–44.
38.
38. Ernst E.Plasma fibrinogen – an independent cardiovascular risk factor. J Internal Med1990; 227: 365–72.
39.
39. Facchini FC, Hollenbeck CB, Jeppesen J, Ida Chen YD, Reaven GM.Insulin reistance and cigarette smoking. Lancet1992; 339: 1128–30.
40.
40. Attvall S, Fowelin J, Lager I, Smith U. Smoking induces insulin resistance – a potential link with the insulin resistance syndrome. J Internal Med1993; 233: 327–32.
42. Kissebah AH, Vydelingum N, Murray R. et al.Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab1982; 54: 254–60.
43.
43. Björntorp P.“Portal” adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arteriosclerosis1990; 10: 493–6.
44.
44. Davey Smith G, Shipley MJ, Rose G.The magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall study. J Epidemiol Community Health1990; 44: 265–70.
45.
45. Lissau I, Sorensen TIA. Parental neglect during childhood and increased risk of obesity in young adulthood. Lancet1994; 343: 324–27.
46.
46. Laurier D, Guiget M, Chau Phong N, Wells JA, Valleson AJ.Prevalence of obesity: a comparative survey in France, United Kingdom and the United States. Int J Obesity1992; 16: 565–72.
47.
47. Nilsson P, Östergren PO, Lindholm L, Scherstén B.Can social class differentials in hypertension be explained by the “general susceptibility” hypothesis?Soc Sci Med1994; 38: 1235–42.
48.
48. Isaksson H, Danielsson M, Rosenhamnier G, Konarski-Svensson JC, Östergren J.Characteristics of patients resistant to antihypertensive drug therapy. J Internal Med1991; 229: 421–6.
49.
49. McKeigue PM, Pierpoint T, Ferrie JE, Marmot MG. Relationship of glucose intolerance and hyperinsulinaemia to body fat pattern in South Asians and Europeans. Diabetologia1992; 35: 785–811.
50.
50. Gould MM, Mohamed-Ali V, Goubet SA, Yudkin JS.Haines AP.Microalbuminuria: association with height and sex in non-diabetic subjects. BMJ1993; 306: 240–2.
51.
51. Brown DC, Byrne CD, Clark PMS, et al.Height and glucose tolerance in adult subjects. Diabetologia1991; 34: 531–3.
52.
52. Barker DJP, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischaemic heart disease. Lancet1989; ii: 577–80.
53.
53. Hales CN, Barker DJP, Clark PMS, et al.Fetal and infant growth and impaired glucose tolerance at age 64 years. BMJ1991; 303: 1019–22.
54.
54. Barker DJP, Bull AR, Osmond C, et al. Fetal and placental size and risk of hypertension in adult life. BMJ1990; 301: 259–62.
55.
55. Barker DJP, Meade TW, Fall CHD, et al. Relation of fetal and infant growth to plasma fibrinogen and factor VII concentrations in adult life. BMJ1992; 304: 148–52.
56.
56. Barker DJP, Hales CN, Fall CHD, Osmond C, Phipps K, Clark PMS. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidemia (syndrome X): relation to reduced fetal growth. Diabetologia1993; 36: 62–7.
57.
57. Vågerö D, Leon D.Ischaemic heart disease and low birth weight: a test of the fetal-origins hypothesis from the Swedish Twin Registry. Lancet1994; 343: 260–63.
58.
58. Huhtasaari H, Asplund K, Stegmayr B, Lundberg V, Wester PO. Trends in cardiovascular risk factors in the Northern Sweden MONICA study: Who are the winners?Cardiovasc Risk Factors1993; 3: 215–21.
59.
59. Brännström I, Weinehall L, Persson LÅ, Wester PO, Wall S.Changing Social patterns of risk factors for cardiovascular disease in a Swedish community intervention programme. Int J Epidemiol1993; 22: 126–37.
60.
60. Smith GD, Egger M. Socioeconomic differentials in wealth and health. Widening inequalities in health-the legacy of the Thatcher years. BMJ1993; 307: 1085–6.