Young Investigators Awards Session

419 Have socioeconomic differences in coronary risk factors changed over 20 years? Results from a population-based study of men between 1978-80 and 1998-2000 SE Ramsay, PH Whincup, SL Hardoon, MC Thomas, RW Morris, SG Wannamethee University College London, London, United Kingdom, St George’s, University of London, London, United Kingdom Topic: Cardiovascular epidemiology Background: Although CHD mortality has declined in the UK population since the late 1970s, the decline has been particularly marked among more affluent subjects. While the decline substantially reflects improvements in established coronary risk factors, little is known about how these have changed in different socioeconomic groups. Aim: To examine whether socioeconomic differences in coronary risk factors in Britain have changed over 20 years between 1978-80 and 1998-2000. Methods: A socioeconomically representative cohort of men aged 40-59 years from 24 British towns was followed-up from 1978-80. Data on blood pressure, cholesterol, body mass index (BMI), cigarette smoking and physical activity were collected at baseline (1978-80) and in 19982000. Social class was based on the longest-held occupation in middle-age. Results: Overall, the prevalence of cigarette smoking declined and mean blood pressure and non-HDL cholesterol levels fell, while mean HDL cholesterol and BMI, and physical activity increased. The higher odds of being a current smoker in manual (lower) compared with nonmanual (higher) social classes in 2000 (age-adjusted odds ratio1⁄42.04; 95%CI 1.68, 2.47) had not changed since 1978-80 (p for interaction social class time 0.51). Men in manual occupations became less likely to be physically inactive compared with non-manual groups (p for interaction 0.04) and more likely to be moderate-vigorously active (p for interaction 0.005). The 20-year increase in mean BMI was 2.34 kg/m2 in the manual compared with 2.01 kg/m2 in the nonmanual group (difference in mean change 0.33 kg/m2; 95%CI 0.14, 0.53; p for interaction 0.001). Mean systolic blood pressure declined more in manual than non-manual groups (difference in mean change 3.6; 95%CI 2.1, 5.3, p for interaction <0.0001). Non-manual groups had a greater mean decline in non-HDL cholesterol (difference in mean change 0.18 mmol/l; 95%CI 0.11, 0.25, p for interaction <0.0001) and a greater mean increase in HDL-cholesterol (difference in mean change 0.04 mmol/l; 95%CI 0.02, 0.06, p for interaction < 0.0001). Conclusions: Since the 1980s, socioeconomic differences in physical activity and blood pressure may have been reduced, while those in cigarette smoking have persisted. Socioeconomic differences in BMI, non-HDL and HDL-cholesterol levels appeared to have worsened, with more unfavourable changes in lower socioeconomic groups. Continuing priority is needed to improve adverse cardiovascular risk profiles in socially disadvantaged groups in the UK.