Cumulative social risk (CSR), defined as experiencing more than one social risk factor,
is associated with a significant increase in cardiovascular mortality. However, it
is unclear whether CSR is associated with prevalent silent myocardial infarction (SMI),
and whether their joint presence is predictive of mortality more than the presence
of CSR in isolation. This analysis included 6,708 participants from the third National
Health and Nutrition Examination Survey who were free of clinical cardiovascular disease
at the time of enrollment. Baseline social risk factors (poverty-income ratio <1,
minority race, education <12 grade, and living single) were used to create the CSR
score with values ranging from 0 to ≥3. SMI was defined as electrocardiographic evidence
of MI in the absence of clinical MI. In a multivariable-adjusted logistic regression
model, baseline CSR ≥ 3 (vs 0) was associated with a higher prevalence of SMI (odds
ratio [95% confidence interval]: 2.21 [1.16 to 4.23]). Over a median follow-up of
14 years, there were 2,151 all-cause deaths. Compared with CSR of 0 and no SMI, the
risk of mortality with CSR was higher in the presence of SMI than without SMI (multivariable
adjusted Hazard Ratios [95% confidence intervals] with vs without SMI were 1.76 [1.13
to 2.75] vs 1.27 [1.10 to 1.46] for CSR≥ 3; 2.06 [1.31 to 3.24] vs 1.21 [1.06 to 1.39]
for CSR = 2; and 2.02 [1.31 to 3.12] vs 1.33 [0.63 to 2.82] for CSR = 1, respectively).
In conclusion, exposure to CSR is associated with increased risk of SMI, and concomitant
presence of SMI with CSR is associated with a higher risk of mortality than presence
of CSR alone.
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Article info
Publication history
Published online: April 10, 2020
Received in revised form:
March 13,
2020
Received:
January 24,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
