Endothelial Function: The Impact of Objective and Subjective Socioeconomic Status on Flow-Mediated Dilation

Annals of Behavioral Medicine, Apr 2010

Background Although objective and subjective indicators of socioeconomic status (SES) are linked to cardiovascular disease (CVD), little is known about their relationship to endothelial dysfunction, which often precedes CVD. Purpose This study examined how objective and subjective SES relate to brachial artery flow-mediated dilation (FMD). Methods FMD was assessed in 72 healthy adults (mean age 36 years). The MacArthur Scale of Subjective Social Status assessed perceived social standing in the USA (SSS-USA) and local community (SSS-Community). Objective SES measures included income and the Hollingshead Two-Factor Index of Social Position (education, occupation). Results Adjusted regressions revealed that SSS-Community positively correlated with FMD (p < 0.05) and explained 8% of the variance. No other SES measures were significant for FMD. The association between FMD and SSS-Community remained significant (p < 0.01) after adjustment for objective SES and other covariates. Conclusions Lower subjective social status in one’s community may be linked to CVD via impaired vasodilation.

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Endothelial Function: The Impact of Objective and Subjective Socioeconomic Status on Flow-Mediated Dilation

Denise C. Cooper 0 Ph.D. 0 Milos S. Milic 0 M.D. 0 Ph.D. 0 Paul J. Mills 0 Ph.D. 0 Wayne A. Bardwell 0 Ph.D. 0 Michael G. Ziegler 0 M.D. 0 Joel E. Dimsdale 0 M.D. 0 0 W. A. Bardwell Moores University of California San Diego Cancer Center , La Jolla, CA, USA 1 0804, La Jolla, CA 92093-0804, USA Background Although objective and subjective indicators of socioeconomic status (SES) are linked to cardiovascular disease (CVD), little is known about their relationship to endothelial dysfunction, which often precedes CVD. Purpose This study examined how objective and subjective SES relate to brachial artery flow-mediated dilation (FMD). Methods FMD was assessed in 72 healthy adults (mean age 36 years). The MacArthur Scale of Subjective Social Status assessed perceived social standing in the USA (SSSUSA) and local community (SSS-Community). Objective SES measures included income and the Hollingshead TwoFactor Index of Social Position (education, occupation). Results Adjusted regressions revealed that SSS-Community positively correlated with FMD (p<0.05) and explained 8% of the variance. No other SES measures were significant for FMD. The association between FMD and SSS-Community remained significant (p<0.01) after adjustment for objective SES and other covariates. Conclusions Lower subjective social status in one's community may be linked to CVD via impaired vasodilation. - Researchers in several countries note that socioeconomic status (SES) shows graded inverse associations with cardiovascular morbidity and mortality, independent of traditional risk factors [1]. Recent declines in cardiovascular disease (CVD) have been less prominent in people of lower social classes [2]. Although reduced access to health care likely plays a role in many countries, such as the USA, the SESCVD gradient also is found in countries with universal health care [3]. Social class differences in the prevalence of adverse health behaviors, such as smoking and physical inactivity, also contribute to the inverse relationship between SES and CVD [4]. However, studies show that the SESCVD gradient is still found after adjusting for differences in health behaviors and traditional risk factors [1, 2]. Although SES has been linked to a variety of CVD measures [57], little is known about the relationship between SES and endothelial dysfunction. Endothelial dysfunction refers to shifts in endothelial processes that lead to decreased vasodilation. With normal function of the endothelium, vascular homeostasis is maintained, and vasoconstriction is limited by secretion of a variety of substances (e.g., nitric oxide), which cause vascular smooth muscle relaxation and artery dilation [8]. Endothelial dysfunction is observed in the early stages of atherosclerosis and is associated with increased plaque rupture in myocardial infarction and other adverse outcomes [8, 9]. Endothelial function can be evaluated with the emerging technique of flow-mediated dilation (FMD), which noninvasively measures endothelium-dependent vasodilation elicited by reactive hyperemia [10]. In response to increased shear stress induced by reactive hyperemia, the endothelium is stimulated to produce and release nitric oxide, which relaxes vascular smooth muscle and produces a measurable increase in artery diameter. FMD refers to the percentage of post-stimulation change in brachial artery diameter relative to baseline [11]. It is highly correlated with invasive endothelial testing and is inversely associated with cardiovascular risk [1215]. Several prospective studies support a prognostic value for FMD in predicting adverse cardiovascular outcomes among community samples and patient populations [1621]. Parallel to research on behavioral and psychosocial risk factors for CVD [2], several studies suggest that unhealthy behaviors (e.g., physical inactivity) [22] and a variety of psychosocial characteristics (e.g., depressed mood, stress) [2326] are linked to endothelial impairment. Despite the substantial literature linking CVD to SES, endothelial function has not been well studied with regard to SES among adults. However, some null findings have been reported for FMD in studies of childhood SES, as measured by the occupational status of the childrens parents [2729]. Those nonsignificant findings for childhood SES could have been due in part to the young ages of the subjects and to the potential limitations of objectively measured SES (e.g., parental occupation). Although occupational status and other objective measures of SES (e.g., education, income) have been linked to CVD [14], these narrowly defined measures cannot capture all the dimensions of social status that have potential relevance to health [30]. Perceptions about ones standing in society or on the social ladder relative to other people may reflect a cognitive averaging of several standard markers of social class (e.g., income, education, occupation, spouses occupation, home ownership), along with more nuanced aspec (...truncated)


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Denise C. Cooper, Milos S. Milic, Paul J. Mills, Wayne A. Bardwell, Michael G. Ziegler, Joel E. Dimsdale. Endothelial Function: The Impact of Objective and Subjective Socioeconomic Status on Flow-Mediated Dilation, Annals of Behavioral Medicine, 2010, pp. 222-231, Volume 39, Issue 3, DOI: 10.1007/s12160-010-9181-9