Diabetes patients on low incomes are at higher risk for atherosclerosis and related cardiovascular disease (CVD) than those who earn more, show results from a Canadian study.

Diabetes is known to be more prevalent among lower socioeconomic groups, whereas CVD has traditionally been inversely related to socioeconomic status, say researchers.

Doreen Rabi (University of Calgary, Alberta) investigated links between income and CV health in 4596 patients with diabetes who underwent cardiac catheterization in Calgary, Canada between January 1st, 2000 and December 31st, 2002.

Suitable patients were identified using the Alberta Provincial Project for Assessing Outcomes in Coronary Heart Disease (APPROACH) database, which was then merged with the Canadian 2001 Census data on median household income per dissemination area using patient postal code data and income quintiles. Degree and severity of CVD were compared across different income quintiles.

As reported in the journal Circulation: Cardiovascular Quality and Outcomes, the team found that lowest income group was highly significantly more likely to have a history of myocardial infarction or congestive heart failure than the highest income group.

Those in the lowest income quintile also had significantly more coronary atherosclerosis than the highest income quintile, as measured by the weighted Duke index, at 7.38 versus 6.67, respectively. Of note, lesion severity did not differ significantly between these two groups at 2.41 versus 2.31 on the Duke severity scale.

Rabi and colleagues found that lowest income patients had significantly higher myocardial jeopardy (the amount of myocardium calculated to be at significant risk for ischemia and ischemic injury) than highest income patients using both Duke and APPROACH scores, at 46.23 versus 36.44 and 45.36 versus 39.96, respectively.

The results show that “low income, diabetic patients in a Canadian city have more atherosclerosis than their wealthier counterparts,” conclude the authors.

“Clearly, more needs to be done to improve the health outcomes of the economically disadvantaged,” they say.

“Healthcare providers and policy makers need to be more cognizant of health risks associated with low income, so that we may be more proactive in preventing poor health outcomes in this vulnerable population.”

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