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Health study: low social status increases the risk of cardiovascular disease

Study leader Prof. Dr Thomas Münzel, Senior Professor at the Centre for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz | © University Medical Center Mainz / Peter Pulkowski

First author Dr Omar Hahad, Research Associate in Cardiology I at the Centre for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz | © Oliver Rüter

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People with a high level of education and a good job often have a lower risk of cardiovascular disease, as a recent study from Mainz shows. What is surprising is that income appears to play a rather subordinate role. The research team argues in favour of taking social and cultural disadvantage seriously as a risk factor.

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A team of cardiological researchers from the University Medical Center Mainz has presented a new study that correlates socioeconomic status (SES) with a person's heart health. According to the study, a low SES is also associated with an increased risk of cardiovascular diseases such as heart attack, heart failure, coronary heart disease, stroke and higher mortality in Germany. While previous international studies have come to similar conclusions, the importance of SES is particularly emphasised in the Mainz study, as access to the healthcare system in this country is less dependent on income.

Long-term study depicts a broad cross-section of society

The analysis is based on data from 15,000 participants in the Mainz Gutenberg Health Study (GHS), which has been running since 2007. People aged between 35 and 74 from Mainz and Rheinhessen were included until 2022. Various characteristics of living conditions were used to determine the SES, such as highest level of education, occupation and income.

"We found that over a study period of ten years (2012-2022), the probability of new cardiovascular diseases was 68% higher in people with low SES. They also had an 86% higher overall mortality rate compared to people with high SES," says study leader and DZHK scientist Prof Dr Thomas Münzel. Münzel is Clinic Director of the Cardiology Centre at the University Medical Center of the Johannes Gutenberg University Mainz.

Heart health: education is more important than income

When comparing the data, the level of education and the type of employment proved to be decisive factors for the risk of cardiovascular disease, while net household income appeared to play a lesser role overall. These associations remained even after taking into account factors such as age, gender, lifestyle and cardiovascular risk factors.

This is remarkable in that people with higher incomes in many countries, including Germany, often have better access to private healthcare. In contrast, people with lower incomes are more likely to rely on state or public healthcare systems. "Our results show that income, and thus perhaps easier access to private insurance, seems to have a smaller impact compared to education and occupation," says Dr Omar Hahad, first author of the study. "Nevertheless, it must be said that all components of SES are substantially interrelated and a clear separation is difficult."

For the time being, the study suggests that people with a higher SES may be less exposed to harmful environmental stressors and are more aware of health issues and lead a healthier lifestyle. Prevention therefore appears to be more important than access to privately paid healthcare in order to prevent cardiovascular disease.

Taking social disadvantage seriously as a health risk

The results of this study should be a wake-up call to take the potential health risks posed by social disadvantage seriously. "There are particular opportunities in prevention for socially disadvantaged people. We want to emphasise the urgency of taking social status into account when assessing risks and preventive measures in order to improve healthcare and reduce social inequalities," says Münzel.

It is therefore important to create an easily accessible and understandable counselling and information service. Knowing about the connection between certain lifestyles and behaviours and cardiovascular diseases is the first step towards preventing them. Education is one of the central tasks to which the National Heart Alliance is committed. Interested parties can find a comprehensive range of advice at Herzmedizin.de (in German only).


Link to the original publication: Cumulative social disadvantage and cardiovascular disease burden and mortality (Hahad et al., 2024)

Source: press release idw (in German only)