Coronary disease & ACSCohort study
Socioeconomic Disparities and Mediators for Recurrent Atherosclerotic Cardiovascular Disease Events After a First Myocardial Infarction
- Cohort study
- causal mediation analysis
- nationwide registry (SWEDEHEART)
Authors' conclusion
Nonparticipation in cardiac rehabilitation, a cardiometabolic risk profile, and persistent smoking mediate income-dependent prognosis after MI.
Study context
- Population
- 1-year survivors of first-ever myocardial infarction (MI) aged 18 to 76 years with Swedish universal health coverage, 2006–202073.8% men
- Participants
- 68,775 survivors
- Exposure
- Lowest vs highest disposable income quintile
- Outcome
- rASCVD
Main finding
As reported in the abstract
mean 5.7-year follow-up
Lowest income quintile vs Highest income quintileHazard ratio (95% CI)
adjusted for age, sex and calendar year
1.63(1.51–1.76)
final model incl. secondary prevention variables
1.38(1.26–1.51)
- rASCVD events
- 7064
Observational data: associations, not effects.
Secondary outcomes
Proportion of excess 15-year rASCVD risk in lowest income quintile mediated
- Nonparticipation in cardiac rehabilitation
- 3.3% (95% CI 2.1-4.8)
- Cardiometabolic risk profile
- 3.9% (95% CI, 2.9-5.5)
- Persistent smoking
- 15.2% (95% 9.1-25.7)
- Poor BP control
- 1.0% (95% CI 0.6-1.5)
- Mediation through optimal statin management negligible
- causal mediation analysis
Original publication
Socioeconomic Disparities and Mediators for Recurrent Atherosclerotic Cardiovascular Disease Events After a First Myocardial Infarction. Circulation. Published 17 July 2023. doi:10.1161/circulationaha.123.064440
Summarised from the published abstract; every number is checked against it