Poorer households, poorer hearts?

Research from Finland and the University of Tasmania, published in JAMA Pediatrics, has examined the association of childhood family socio-economic status in youth on measures of left ventricular mass and diastolic function 31 years later in adulthood. The authors conducted analyses in 2016 on data collected in 1980 and 2011 in the Cardiovascular Risk in Young Finns Study. The study included a group of 1871 participants who reported family socio-economic status (characterised as annual family income) at ages 3 years to 18 years. Left ventricular mass measured echocardiographically is associated with heart failure not related to heart attack, and left ventricular diastolic dysfunction may be a predictor of heart failure, according to background in the study. The authors reported that low family socio-economic status in childhood was associated with increased left ventricular mass and impaired diastolic performance more than 30 years later. This association persisted even after adjusting for age, sex, conventional cardiovascular risk factors in both childhood and adulthood, and the participants’ own socio-economic status in adulthood. Echocardiography was not assessed in childhood, so researchers were unable to determine in what stage of life childhood socio-economic status began to associate with cardiac structure and function. The study population also was racially homogenous, so generalisability of the results was limited to white populations. “These findings further emphasise that approaches of [cardiovascular disease] prevention must be directed also to the family environment of the developing child. Particularly, support for families with low [socio-economic status] may pay off in sustaining cardiovascular health to later life,” the article concluded.

Persistent mental distress linked to increased risk of death in patients with cardiovascular disease

Australian and New Zealand research, published in Heart, has linked persistent moderate to severe mental distress to a significantly heightened risk of death among patients with stable coronary heart disease. No association was found for patients experiencing persistent mild or occasional distress over the long term, the findings showed. The researchers looked at the association between occasional or persistent mental distress and the risk of death in the 950 out of 9014 Long Term Intervention with Pravastatin in Ischaemic Disease (LIPID) trial participants who completed at least four General Health Questionnaires (GHQ-30). All participants were between 31 and 74 years old, had stable coronary heart disease, and had had a heart attack or been admitted to hospital for unstable angina in the preceding 3–36 months. They filled in the GHQ30 questionnaire at 6 months and at 1, 2 and 4 years after the event to gauge their levels of mental distress. This was graded according to severity and the length of time it lasted at each of the assessments: never distressed, occasional (of any severity), persistent mild distress on three or more occasions, and persistent moderate distress on three or more occasions. The participants’ health and survival were then tracked for an average of 12 years. During the monitoring period, 398 people died from all causes and 199 died from cardiovascular disease. The questionnaire responses showed that 587 participants (62%) said they had not been distressed at any of the assessments, while around one in four (27%) said they had experienced occasional distress of any severity. Around one in ten (8%) said they had experienced persistent mild distress, and 35 people (3.7%) complained of persistent moderate distress. People in this last group were nearly four times as likely to have died of cardiovascular disease and nearly three times as likely to have died from any cause as those who said they had not been distressed at any of the assessments. The primary endpoint of the LIPID trial was death from coronary heart disease.  The current analysis was not noted to be as one of the primary or secondary pre-specified LIPID trial endpoints.

Study: sugar tax would benefit low income groups

Research from Deakin University’s Global Obesity Centre has challenged criticism of a proposed sugar sweetened beverage tax which claimed it would unfairly punish disadvantaged groups. The study, published in PLOS Medicine, claims to be the first of its kind to examine the equity of a 20% tax on sales of sugar sweetened beverages in Australia, by assessing potential cost effectiveness, health gains and financial impacts for different socio-economic groups. Its modelling predicts that individuals in Australia’s lowest socio-economic group would receive the greatest health benefits from the tax, and the extra cost to them due to the increased price of soft drinks would be under $5 per year more than the highest socio-economic group per year. Lead author Anita Lal, a PhD candidate in Deakin’s School of Health and Social Development, said that the study showed that a sugar sweetened beverage tax could save $1.73 billion in health care costs over the lifetime of the population. “We estimated the increase in annual spending on sugar sweetened beverages would be an average of $30 per person, or just 60 cents per week, a reasonable cost when the health benefits are taken into account,” Ms Lal said. The study looked at predicted changes in consumption levels due to a change in price and converted that to a change in population body mass index, which then helped predict the reduction in the prevalence of certain diseases related to obesity. Ms Lal said health benefits were likely to be better felt by lower socio-economic groups as they were typically more price sensitive – so more likely to stop buying soft drinks when prices increased – and were also higher consumers of sugary drinks, so there was a greater scope for reduction. Annual tax revenue from the proposal was estimated at $642.9 million in the report. “A 20% tax on sugar sweetened beverages is likely to decrease purchase and consumption, leading to significant health gains and health care cost savings across all socio-economic groups,” Ms Lal said. “However, as a percentage of household expenditure, we found that the lower socio-economic groups will save the most in out-of-pocket health care costs.”


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