[The German Cardiovascular Prevention Study: social gradient for the net effects in prevention of...

Hypercholesterolemia is considered an important risk factor for cardiovascular disease. The net effects of 7 years of a community prevention programme using principally a high-risk strategy (screening, referrals to general practitioner) in the German Cardiovascular Prevention Study (GCP) are analysed according to socioeconomic status (SES). Cholesterol was measured in three subsequent cross-sectional population samples of adults (ages 25-69 years) in 1984-1985, 1988 and 1991-1992 in the regions of Berlin, Bremen, Stuttgart, Karlsruhe with Bruchsal/Mosbach, and Traunstein (n = 11,548, 8743, 8636), in the region of Stuttgart only (n = 1791, 1437, 1313) and in the entire West German population (n = 4790, 5335, 5311) as reference. SES was determine by an additive, multiple index. Variations of means for phases and regions and resultant net differences were calculated. From 1984-1985 to 1991-1992 cholesterol declined from 232.7 to 231.8 mg/dl in the overall regions, from 232.0 to 230.5 mg/dl in Stuttgart, but increased from 233.5 to 236.9 mg/dl in the reference region. In the combined regions net differences according to SES were -4.2%***1) for the upper class, -1.6%** for the middle class and -0.3% for the lower class. Similar results were found comparing Stuttgart with the reference region (-5.4%***, -1.4%, -0.1%). The GCP intervention for hypercholesterolemia was successful basically only for the upper class, if net differences for the means are calculated. Prevention of hypercholesterolemia increased the social gradient in the pooled intervention regions and in Stuttgart.