Copyright © 2004 by the European Society of Cardiology.
Clinical research
Coronary disease in relation to social support and social class in Swedish men
A 15 year follow-up in the study of men born in 1933
a Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
b Section of Preventive Cardiology, Karolinska Institute, Stockholm, Sweden
* Correspondence to: Annika Rosengren, Department of Medicine, Sahlgrenska University Hospital/Östra, SE-416 85 Göteborg, Sweden. Tel: +46-31-3434000; Fax: +46-31-259254
E-mail address: annika.rosengren{at}hjl.gu.se
Received 24 January 2003; revised 29 August 2003; accepted 4 October 2003
Abstract
Aims Low socio-economic status is a well-known risk factor for coronary heart disease (CHD), but the evidence concerning social network has been less consistent. In this prospective cohort study of men we sought to estimate the impact of social network factors on the risk of incident coronary heart disease and mortality from all causes.
Methods and results In a population of 741 men aged 50 at baseline 92 new cases of coronary disease were identified over a follow-up period of 15 years. Social factors included occupational class, two measures of social support—‘emotional attachment’ and ‘social integration’ and a measure of global mental stress. Among the men in the lowest quartile of social integration, there were 13.6 cases (per 1000 observation years), compared to 8.9 in the intermediate two quartiles and 6.0 in the highest quartile (P for trend 0.003). After adjustment for all relevant risk factors the hazard ratio (HR) for the highest, compared with the lowest, quartile was 0.45 (0.24–0.84);P for trend 0.013. Emotional attachment was also associated with significantly reduced risk. The adjusted HR for the lowest quartile was 0.58 (0.37–0.91); P=0.019. No relation between mental stress and risk of CHD, or between low occupational class and risk of CHD was found.
Conclusion In this prospective study of men, we found two dimensions of low social support—low social integration and low emotional attachment—to be predictive of coronary morbidity, independently of other risk factors.
Key Words: Coronary disease • Social integration • Emotional support • Social class • Psychological stress
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