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Stress responsivity and socioeconomic status. A mechanism for increased cardiovascular disease risk?

A. Steptoe, P.J. Feldman, S. Kunz, N. Owen, G. Willemsen, M. Marmot
DOI: http://dx.doi.org/10.1053/euhj.2001.3233 1757-1763 First published online: 2 November 2002

Abstract

Aims Low socioeconomic status is associated with increased cardiovascular disease risk. We hypothesized that psychobiological pathways, specifically slow recovery in blood pressure and heart rate variability following mental stress, partly mediate social inequalities in risk.

Methods and Results Participants were 123 men and 105 women in good health aged 47–58 years drawn from the Whitehall II cohort of British civil servants. Grade of employment was the indicator of socioeconomic status. Cardiovascular measures were monitored during performance of two behavioural tasks, and for 45min following stress. Post-stress return of blood pressure and heart rate variability to resting levels was less complete after 45min in the medium and low than in the high grade of employment groups. The odds of failure to return to baseline by 45min in the low relative to the high grade of employment groups were 2·60 (95% CI 1·20–5·65) and 3·85 (1·48–10·0) for systolic and diastolic pressure, respectively, and 5·19 (1·88–18·6) for heart rate variability, adjusted for sex, age, baseline levels and reactions to tasks. Subjective ratings of task difficulty, involvement and stress did not differ by socioeconomic status.

Conclusions Lower socioeconomic status is associated with delayed recovery in cardiovascular function after mental stress. Impaired recovery may reflect heightened allostatic load, and constitute a mechanism through which low socioeconomic status enhances cardiovascular disease risk.

  • Socioeconomic status, mental stress, cardiovascular reactivity, coronary heart disease.