Emmanuel Wiernik1, Pierre Meneton2, Jean-Philippe Empana3, Jack Siemiatycki4, Nicolas Hoertel5, Hélène Vulser5, Hermann Nabi6, Frédéric Limosin5, Sébastien Czernichow7, Marcel Goldberg8, Anna Ozguler9, Marie Zins8, Cédric Lemogne5. 1. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France. Electronic address: emmanuel.wiernik@inserm.fr. 2. Inserm U1142 LIMICS, UMR_S 1142 Sorbonne Université, UPMC Université Paris 06, Université Paris 13, France. 3. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Inserm U970, Paris Cardiovascular Research Centre, France. 4. Ecole de santé publique, Université de Montréal, Canada. 5. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France; AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, Paris, France. 6. Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Inserm, Villejuif, France. 7. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; AP-HP, Department of Nutrition, Georges Pompidou European Hospital, Paris, France; Inserm, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France. 8. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Inserm, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France. 9. Inserm, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France.
Abstract
BACKGROUND: Recent evidence suggests that the association of psychological variables with the risk of coronary heart disease (CHD) might depend upon socioeconomic status (SES). However, it is unclear whether the association between depressive symptoms and CHD risk might differ according to three SES indicators (education, occupational status and household monthly income). METHODS: Among 34,836 working participants of the French CONSTANCES cohort (16,221 men, mean age [SD]: 44.0 [10.4] years) without history of cardiovascular disease, depressive symptoms were assessed with the Center of Epidemiologic Studies Depression scale (CES-D). The Framingham risk equation calibrated to the French population estimated the participant's 10-year risk of CHD. Associations between depressive symptoms and CHD risk were estimated using linear regression models in SES strata. RESULTS: The estimated 10-year risk of CHD was 16.9% in men and 1.8% in women. In men, the increased CHD risk in those with (versus without) depressive symptoms was more pronounced as occupational status decreased, being 0.65% (-0.57; 1.88), 1.58% (0.50; 2.66) and 3.19% (1.30; 5.07) higher in individuals of high, medium and low occupational status, respectively (p for interaction: 0.01). In contrast, effect modification by education or household income was less evident, despite similar trends. In women, no effect modification was found whatever the SES indicator. CONCLUSIONS:Depressive symptoms and 10-year estimated CHD risk were more tightly linked in individuals of lower SES, at least in men. Occupational status was the SES indicator that displays the most obvious effect modification on this association.
RCT Entities:
BACKGROUND: Recent evidence suggests that the association of psychological variables with the risk of coronary heart disease (CHD) might depend upon socioeconomic status (SES). However, it is unclear whether the association between depressive symptoms and CHD risk might differ according to three SES indicators (education, occupational status and household monthly income). METHODS: Among 34,836 working participants of the French CONSTANCES cohort (16,221 men, mean age [SD]: 44.0 [10.4] years) without history of cardiovascular disease, depressive symptoms were assessed with the Center of Epidemiologic Studies Depression scale (CES-D). The Framingham risk equation calibrated to the French population estimated the participant's 10-year risk of CHD. Associations between depressive symptoms and CHD risk were estimated using linear regression models in SES strata. RESULTS: The estimated 10-year risk of CHD was 16.9% in men and 1.8% in women. In men, the increased CHD risk in those with (versus without) depressive symptoms was more pronounced as occupational status decreased, being 0.65% (-0.57; 1.88), 1.58% (0.50; 2.66) and 3.19% (1.30; 5.07) higher in individuals of high, medium and low occupational status, respectively (p for interaction: 0.01). In contrast, effect modification by education or household income was less evident, despite similar trends. In women, no effect modification was found whatever the SES indicator. CONCLUSIONS:Depressive symptoms and 10-year estimated CHD risk were more tightly linked in individuals of lower SES, at least in men. Occupational status was the SES indicator that displays the most obvious effect modification on this association.
Authors: Michelle L Meyer; Feng-Chang Lin; Andrea Jaensch; Ute Mons; Harry Hahmann; Wolfgang Koenig; Hermann Brenner; Dietrich Rothenbacher Journal: PLoS One Date: 2019-03-07 Impact factor: 3.240