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Lifestyle factors biggest cause of heart disease risk variation

Health promotion work could have largest impact in deprived areas

Adrian O'Dowd

Friday, 14 October 2016

Women living in deprived areas of the UK with poor education are at greater risk of coronary heart disease largely due to lifestyle factors such as smoking and physical inactivity, according to a study* published in the open access journal BMC Medicine.

The research included 1.2 million participants in the Million Women Study – about one in four of all UK women born in the 1930s and 1940s.

Researchers analysed data and found that during 12 years of follow-up between 1996 and 2008, 71,897 women aged 50 and over developed heart disease and 6,032 died as a result.

This large number made it possible to look carefully at the extent to which four lifestyle factors - smoking, alcohol consumption, physical activity and body mass index (BMI) - accounted for the known social inequalities in heart disease.

The researchers found that, without taking into account the four lifestyle factors, women who had completed compulsory schooling with no qualifications had almost twice the risk of developing heart disease or dying from it than women who had a degree.

Similarly, women in the most deprived areas had twice the risk of heart disease compared to women from the least deprived areas.

Dr Sarah Floud, lead author from the University of Oxford, said: “Women with fewer educational qualifications and from more deprived areas of the UK were more likely to smoke, be obese and be physically inactive, although they consumed slightly less alcohol.

“We found that these factors accounted for most of the social inequalities in heart disease risk. The most important factor, however, was smoking: it alone accounted for about half of the associations of heart disease with education and deprivation.”

It was important to recognise that these health-related behaviours were themselves influenced by education and deprivation, she added, and that it was harder to change them without resources.

“Our results underline the importance of existing public health policies to reduce smoking and to promote healthy eating and exercise,” said Dr Floud.

“The more disadvantaged members of society are often the hardest to reach, but the findings from this study emphasise the potential gains that could be made in reducing rates of heart disease if they are reached.”

Catherine Kelly, director of prevention, survival and support at the British Heart Foundation, which helped fund the study, said: “This research reinforces previous studies we’ve funded that highlight the stark inequalities in rates of heart disease between the most and least affluent in our society.

“It’s an important reminder that tackling heart health inequalities should remain a public health priority, and that further research is crucial to identify the most effective ways of supporting people to make sustainable changes to their lifestyle.”


* Floud, S, et al. The role of health-related behavioural factors in accounting for inequalities in coronary heart disease risk by education and area deprivation: prospective study of 1.2 million UK women. BMC Medicine2016 14:145, published 13 October 2016. DOI: 10.1186/s12916-016-0687-2

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