Risk factor socioeconomic status

"Wealth is both an enemy and a friend."

Nepalese proverb

Prevalence of CVD risk factors by education in Canada

Percentage of people aged 18 to 74 years with high levels of physical inactivity and high cholesterol, by educational level, age standardized 1986-1992

men women physical inactivity high cholesterol physical inactivity high cholesterol physical inactivity high cholesterol

secondary school not completed

47%

42%

46%

43%

secondary school completed

37%

33%

45%

42%

university degree obtained

37%

31%

38%

35%

The CVD mortality gap in the USA

Percentage increased CVD mortality of lowest socioeconomic (SE) group over highest SE group, in people aged 25 to 64 years 1969-1998

women men

1969-1970 1997-1998

monthly household income

Prevalence of high blood pressure by income in Trinidad and Tobago

Percentage of women aged 24 to 85 years with blood pressure of 140/90 mmHg or above, or currently treated

2001

less than US$134

US$ 134-267

US$ 268-533

US$ US$ more than

534-1067 1068-2133 US$2133

less than US$134

US$ 134-267

US$ 268-533

US$ US$ more than

534-1067 1068-2133 US$2133

monthly household income

Educational level and obesity in Italy

Percentage increased risk of obesity in people aged 35 to 74 years, 380%

in comparison with university graduates 1998

25G%

upper secondary education diploma

25G%

no qualification

In China, years of education are more important than occupation, income or marital status in relation to cardiovascular risk factors, especially cigarette smoking.

Smoking and occupation in Uganda

Percentage of women aged 15 to 54 years and men aged 15 to 59 years who currently smoke daily by category of work 2000-2001

men women

34%

33%

29%

4%

3%

M

agriculture, unskilled self-employed manual

agriculture, unskilled self-employed manual

skilled manual

sales professional, unemployed technical, (previous managerial, 12 months) clerical

Income and obesity in Saudi Arabia

Percentage of people aged 20 years and above with Body Mass Index of more than 30 kg/m2 1990-1993 _

income less than US$ US$ more than

US$533 533-1066 1067-2133 US$2134

Smoking by years of education in South Africa

Smoking by years of education in South Africa

Prevalence of diabetes by income in India

Percentage of people aged 20 years and above with diabetes, by income level 2000

less than US$ more than US$111 112-223 US$223

women men

Widespread misconceptions persist about heart disease, often thought to be primarily a disease of middle-aged men. In reality, cardiovascular disease affects as many women as men, albeit at an older age. Many women still believe that they are more at risk from cancer than from heart disease.

Risk factors for CVD are similar for men and women, but tobacco use is more dangerous in women. In addition, high blood triglycerides are an important cause of atherosclerosis in young women, but not in young men. The menopause has no direct effect, but hormone replacement therapy increases the risk of CVD.

Heart disease is under-detected in women, particularly younger women. In developed countries, women are less likely to be referred to a heart specialist, to be hospitalized, to be prescribed medicine or invasive treatment, or to be referred for exercise testing or echocardiography. Women are more likely to enter the medical system with the diagnosis of a second heart attack.

After a first stroke, women are kept in hospital longer, and remain more disabled than men receiving similar care. More research is needed to improve our understanding of the differences in responses to treatment in men and women.

In the interim, however, adherence to the published guidelines for the prevention and control of heart disease and stroke seems prudent.

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