OBJECTIVE: People's socioeconomic status (SES) has a major impact on the risk of atherosclerotic cardiovascular disease (ASCVD) in primary prevention. In patients with existing ASCVD these associations are less documented. Here, we evaluate to what extent SES is still associated with patients' risk profile in secondary prevention. METHODS: Based on results from a large sample of patients with coronary heart disease from the European Action on Secondary and Primary Prevention through Intervention to Reduce Events study, the relationship between SES and cardiovascular risk was examined. A SES summary score was empirically constructed from the patients' educational level, self-perceived income, living situation and perception of loneliness. RESULTS: Analyses are based on observations in 8261 patients with coronary heart disease from 27 countries. Multivariate logistic regression analyses demonstrate that a low SES is associated (OR, 95% CI) with lifestyles such as smoking in men (1.63, 1.37 to 1.95), physical activity in men (1.51, 1.28 to 1.78) and women (1.77, 1.32 to 2.37) and obesity in men 1.28 (1.11 to 1.49) and women 1.65 (1.30 to 2.10). Patients with a low SES have more raised blood pressure in men (1.24, 1.07 to 1.43) and women (1.31, 1.03 to 1.67), used less statins and were less adherent to them. Cardiac rehabilitation programmes were less advised and attended by patients with a low SES. Access to statins in middle-income countries was suboptimal leaving about 80% of patients not reaching the low-density lipoprotein cholesterol target of <1.8 mmol/L. Patients' socioeconomic level was also strongly associated with markers of well-being. CONCLUSION: These results illustrate the complexity of the associations between SES, well-being and secondary prevention in patients with ASCVD. They emphasise the need for integrating innovative policies in programmes of cardiac rehabilitation and secondary prevention.

Centre for Cardiovascular Prevention 1st Faculty of Medicine and Thomayer Hospital Charles University Prague Czech Republic

Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Kraków Poland

Department of Public Health and Primary Care Ghent University Ghent Belgium

Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands

National Institute for Prevention and Cardiovascular Health National University of Ireland Galway Galway Ireland

Preventive Cardiology Unit Department of Vascular Medicine Division of Internal Medicine University Medical Centre Ljubljana Ljubljana Slovenia

Shupik's Medical Academy of Postgraduate Education Kiev Ukraine

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$a OBJECTIVE: People's socioeconomic status (SES) has a major impact on the risk of atherosclerotic cardiovascular disease (ASCVD) in primary prevention. In patients with existing ASCVD these associations are less documented. Here, we evaluate to what extent SES is still associated with patients' risk profile in secondary prevention. METHODS: Based on results from a large sample of patients with coronary heart disease from the European Action on Secondary and Primary Prevention through Intervention to Reduce Events study, the relationship between SES and cardiovascular risk was examined. A SES summary score was empirically constructed from the patients' educational level, self-perceived income, living situation and perception of loneliness. RESULTS: Analyses are based on observations in 8261 patients with coronary heart disease from 27 countries. Multivariate logistic regression analyses demonstrate that a low SES is associated (OR, 95% CI) with lifestyles such as smoking in men (1.63, 1.37 to 1.95), physical activity in men (1.51, 1.28 to 1.78) and women (1.77, 1.32 to 2.37) and obesity in men 1.28 (1.11 to 1.49) and women 1.65 (1.30 to 2.10). Patients with a low SES have more raised blood pressure in men (1.24, 1.07 to 1.43) and women (1.31, 1.03 to 1.67), used less statins and were less adherent to them. Cardiac rehabilitation programmes were less advised and attended by patients with a low SES. Access to statins in middle-income countries was suboptimal leaving about 80% of patients not reaching the low-density lipoprotein cholesterol target of <1.8 mmol/L. Patients' socioeconomic level was also strongly associated with markers of well-being. CONCLUSION: These results illustrate the complexity of the associations between SES, well-being and secondary prevention in patients with ASCVD. They emphasise the need for integrating innovative policies in programmes of cardiac rehabilitation and secondary prevention.

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$a van de Luitgaarden, Inge A T $u Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

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$a De Smedt, Delphine $u Department of Public Health and Primary Care, Ghent University, Ghent, Belgium

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$a Vynckier, Pieter $u Department of Public Health and Primary Care, Ghent University, Ghent, Belgium

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$a Bruthans, Jan $u Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Prague, Czech Republic

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$a Fras, Zlatko $u Preventive Cardiology Unit, Department of Vascular Medicine, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia

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$a Jankowski, Piotr $u Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland

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$a Dolzhenko, Marina $u Shupik's Medical Academy of Postgraduate Education, Kiev, Ukraine

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$a Kotseva, Kornelia $u National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland

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$a Wood, David $u National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland

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$a De Backer, Guy $u Department of Public Health and Primary Care, Ghent University, Ghent, Belgium

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