Socio-economic status, cardiovascular risk factors, and coronary atherosclerosis: a SCOT-HEART trial analysis.
Jonathan R Weir-McCall, Ryan Wereski, Jian Chen et al.
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In 30 seconds
This post-hoc analysis of a multicentre randomised trial examined socioeconomic status (SES) in relation to coronary CT angiography (CCTA) plaque features, management, and cardiovascular outcomes. SES was available for 3948 participants; 1629 had scans suitable for quantitative plaque analysis. Although participants in the most deprived group were younger and less likely to have severe stenosis or multivessel disease, adjusted quantitative plaque burden did not differ across SES groups. Over a median 4.75 years, CCTA-guided management was associated with similar treatment changes and reductions in coronary heart disease death or non-fatal myocardial infarction in low- and high-SES groups; the interaction was not significant (P = 0.35).
Key findings
- After adjustment for cardiovascular risk factors, quantitative coronary plaque burden did not differ between socioeconomic groups.
- The most deprived participants were younger, had lower cardiovascular risk, and were less likely to have severe stenosis or multivessel disease.
- CCTA-guided management was associated with similar changes in medical therapy and reductions in coronary heart disease death or non-fatal myocardial infarction across low- and high-SES groups.
- There was no evidence that SES modified the outcome association between CCTA-guided management and cardiovascular outcomes (P = 0.35).
Why it matters
The findings suggest that socioeconomic differences in coronary disease severity may largely reflect modifiable cardiovascular risk factors rather than an independent association with plaque burden. Similar observed management and outcome patterns across SES groups are relevant when considering whether CCTA-guided care performs differently across socioeconomic strata, while the post-hoc nature of the analysis warrants cautious interpretation.
What to keep in mind
This was a post-hoc analysis, and quantitative plaque analysis was available for 1629 participants, fewer than the 3948 with SES data.