Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review

BACKGROUND: A relatively consistent body of research supports an inverse graded relationship between socioeconomic status (SES) and cardiovascular disease (CVD). More recently, researchers have proposed various life course SES hypotheses, which posit that the combination, accumulation, and/or interactions of different environments and experiences throughout life can affect adult risk of CVD. Different life course designs have been utilized to examine the impact of SES throughout the life course. This systematic review describes the four most common life course hypotheses, categorizes the studies that have examined the associations between life course SES and CVD according to their life course design, discusses the strengths and weaknesses of the different designs, and summarizes the studies' findings. METHODS: This research reviewed 49 observational studies in the biomedical literature that included socioeconomic measures at a time other than adulthood as independent variables, and assessed subclinical CHD, incident CVD morbidity and/or mortality, and/or the prevalence of traditional CVD risk factors as their outcomes. Studies were categorized into four groups based upon life course design and analytic approach. The study authors' conclusions and statistical tests were considered in summarizing study results. RESULTS: Study results suggest that low SES throughout the life course modestly impacts CVD risk factors and CVD risk. Specifically, studies reviewed provided moderate support for the role of low early-life SES and elevated levels of CVD risk factors and CVD morbidity and mortality, little support for a unique influence of social mobility on CVD, and consistent support for the detrimental impact of the accumulation of negative SES experiences/conditions across the life course on CVD risk. CONCLUSIONS: While the basic life course SES study designs have various methodologic and conceptual limitations, they provide an important approach from which to examine the influence of social factors on CVD development. Some limitations may be addressed through the analysis of study cohorts followed from childhood, the evaluation of CVD risk factors in early and middle adulthood, and the use of multiple SES measures and multiple life course analysis approaches in each life course study

Neurovascular dysfunction in vascular dementia, Alzheimer’s and atherosclerosis

Efficient blood supply to the brain is of paramount importance to its normal functioning and improper blood flow can result in potentially devastating neurological consequences. Cerebral blood flow in response to neural activity is intrinsically regulated by a complex interplay between various cell types within the brain in a relationship termed neurovascular coupling. The breakdown of neurovascular coupling is evident across a wide variety of both neurological and psychiatric disorders including Alzheimer’s disease. Atherosclerosis is a chronic syndrome affecting the integrity and function of major blood vessels including those that supply the brain, and it is therefore hypothesised that atherosclerosis impairs cerebral blood flow and neurovascular coupling leading to cerebrovascular dysfunction. This review will discuss the mechanisms of neurovascular coupling in health and disease and how atherosclerosis can potentially cause cerebrovascular dysfunction that may lead to cognitive decline as well as stroke. Understanding the mechanisms of neurovascular coupling in health and disease may enable us to develop potential therapies to prevent the breakdown of neurovascular coupling in the treatment of vascular brain diseases including vascular dementia, Alzheimer’s disease and stroke

Socio-economic conditions in childhood and mortality and morbidity caused by coronary heart disease in adulthood in rural Finland

In this study, the hypothesis that bad socio-economic conditions in childhood may increase the probability of coronary heart disease in adulthood is examined. The study is based partly on the data of the East-West Study in Finland, which is part of the Seven Countries Study. The study began with 823 men in Eastern Finland and 888 men in Western Finland in 1959. The mortality and morbidity of the cohorts were followed from 1959 to 1974. Risk factors were measured in medical examinations in 1959, 1964, 1969 and 1974. Parents of those included in the sample were traced by using parish registers from 1900 to 1919. Over 90% of those in the East-West Study were found. The parents' socio-economic position (socio-economic conditions in childhood) was determined. According to our findings, the relative risks of coronary death, myocardial infarction and ischemic heart disease are systematically increased for those born landless in East Finland. Variables partly explaining the increased risk were body height and smoking. The effect of cholesterol was negligible.

Farmers' occupational health programme in Finland, 1979-1987

At the beginning of 1985, the National Board of Health in Finland issued directives for the initiation of farmers' occupational health services in municipal health care centres. The directives were based on the evaluation study on farmers' occupational health services in Finland. The main aim of this study is to analyse the current problems of the farmers' occupational health care system and to analyse how effective the system is. The efficiency of the occupational health services has been surveyed with postal inquiries twice, first in 1982 and later in 1986. The farmers' knowledge of appropriate means for reducing hazardous exposures had improved significantly since the initiation of the occupational health services. The effect of the occupational health services was evident particularly in the more effective use of personal safety devices. The limited resources at the municipal health care centres form the main obstacle in the provision of occupational health services for all farmers who would like to have them. 25-35% of the farmers in Finland (total 45,000 farmers) are willing to participate in the occupational health care system. Participation is voluntary for self-employed farmers.farmers occupational health services health education evaluation study