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Socioeconomic status, cardiovascular risk factors and coronary atherosclerosis: a SCOT-HEART trial analysis
Jonathan R Weir-McCall1,2,3,4, Ryan Wereski5, Jian Chen1
1Department of Radiology, School of Medicine, University of Cambridge, Cambridge, UK.
Insights
Socioeconomic status does not independently predict coronary artery disease severity. Coronary computed tomography angiography (CCTA)-guided preventive therapies benefit individuals across all socioeconomic groups equally.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Public Health
Background:
- Socioeconomic status (SES) is linked to health disparities.
- Understanding SES impact on coronary artery disease (CAD) is crucial for equitable care.
Purpose of the Study:
- To examine the relationship between SES, coronary computed tomography angiography (CCTA) plaque burden, management, and outcomes.
- To assess if SES influences CAD severity and treatment effectiveness.
Main Methods:
- Post-hoc analysis of a multicenter randomized trial.
- Assessed associations between SES and CCTA plaque features (qualitative and quantitative).
- Examined SES interaction with cardiovascular outcomes.
Main Results:
- No significant difference in quantitative plaque burden between SES groups after risk factor adjustment.
- CCTA-guided management led to similar improvements in medical therapy and reduced risk of coronary heart disease events in low and high SES groups.
- SES was not an independent predictor of CAD severity.
Conclusions:
- Modifiable risk factors, not SES itself, primarily determine the association with CAD severity.
- CCTA-guided preventive therapies offer comparable benefits across socioeconomic strata.
- Equitable outcomes are achievable with appropriate cardiovascular risk management.
Aims:
To investigate the relationship between socioeconomic status, plaque burden on coronary computed tomography angiography (CCTA), management and outcomes.
Methods:
In a post-hoc analysis of a multicentre randomised control trial, we assessed associations between socioeconomic status and qualitative (stenosis, adverse plaque characteristics) and quantitative (total plaque, calcified plaque, non-calcified and low attenuation) CCTA plaque features and examined the interaction of socioeconomic status on cardiovascular outcomes.
Results:
Socioeconomic status was available in 3948 participants of whom 1989 were randomised to CCTA and 1629 scans were suitable and available for quantitative plaque analysis. Within these 1629 participants, 15% were from the lowest socioeconomic quintile and 25% from the highest socioeconomic quintile. Participants in the most deprived socioeconomic group were younger, had lower cardiovascular risk, and less likely to have severe stenosis or multivessel disease. After adjustment for cardiovascular risk factors, there was no difference in quantitative plaque burden between socioeconomic groups. After a median of 4.75 years follow-up, CTCA-guided management was associated with similar changes in medical therapy, and similar reductions in the risk of coronary heart disease death, or non-fatal myocardial infarction in low and high socioeconomic groups, with no difference between the base and interaction models (p=0.35).
Conclusion:
Socioeconomic status is not an independent predictor of coronary artery disease severity, rather, the association is mostly determined by modifiable risk factors. Preventive therapies, guided by CCTA, achieves similar benefits in both low and high socioeconomic status individuals.
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