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Original article

Vol. 149 No. 1516 (2019)

Association between income and control of cardiovascular risk factors after acute coronary syndromes: an observational study

  • Emmanuelle Jaquet
  • Baris Gencer
  • Reto Auer
  • Karine Moschetti
  • Olivier Muller
  • Christian M. Matter
  • Thomas F. Lüscher
  • Francois Mach
  • Nicolas Rodondi
  • Patrick Bodenmann
  • David Nanchen
Cite this as:
Swiss Med Wkly. 2019;149:w20049



The role of income in cardiovascular disease prevention after an acute coronary syndrome (ACS) remains unclear. We aimed to assess the association between income and control of cardiovascular risk factors one year after an ACS in a country with universal health insurance.


Between 2013 and 2014, we studied 255 consecutive patients with ACS in an observational study in a university hospital in Switzerland in which self-reported household income was assessed. We classified patients into two categories based on the median income in Switzerland: higher than CHF 6000 (€ 5300) or less than or equal to CHF 6000 (€ 5300) per month. One year after discharge, patients were evaluated for the achievement of lipid and blood pressure targets, smoking cessation and drug adherence. Multivariate odds ratios (OR) were adjusted for age, sex, education, living status and working status.


Overall, 52.2% (n = 133) of patients with ACS were in the low-income category and 47.8% (n = 122) were in the high-income category. One year after discharge, high-income patients had higher rates of smoking cessation (64.2 vs 30.1%, multivariate-adjusted odds ratio (OR) 3.82, 95% confidence interval (CI) 1.58–9.24) and blood pressure target achievement (78.6 vs 60.2%, multivariate-adjusted OR 2.19, 95% CI 1.09–4.41) compared to those in the low-income category. There were no differences regarding adherence to drugs or lipid control between the two income groups.


A high household income was associated with a higher rate of smoking cessation and better control of blood pressure one year after ACS, independently of education, living status and working status.


  1. Alter DAFB, Franklin B, Ko DT, Austin PC, Lee DS, Oh PI, et al. Socioeconomic status, functional recovery, and long-term mortality among patients surviving acute myocardial infarction. PLoS One. 2013;8(6):e65130. doi:.
  2. Ng DK, Brotman DJ, Lau B, Young JH. Insurance status, not race, is associated with mortality after an acute cardiovascular event in Maryland. J Gen Intern Med. 2012;27(10):1368–76. doi:.
  3. Fabreau GELA, Leung AA, Southern DA, Knudtson ML, McWilliams JM, Ayanian JZ, et al. Sex, socioeconomic status, access to cardiac catheterization, and outcomes for acute coronary syndromes in the context of universal healthcare coverage. Circ Cardiovasc Qual Outcomes. 2014;7(4):540–9. doi:.
  4. Tang KL, Rashid R, Godley J, Ghali WA. Association between subjective social status and cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis. BMJ Open. 2016;6(3):e010137. doi:.
  5. Jones DAHJ, Howard JP, Rathod KS, Gallagher SM, Knight CJ, Jain AK, et al. The impact of socio-economic status on all-cause mortality after percutaneous coronary intervention: an observational cohort study of 13,770 patients. EuroIntervention. 2015;10(10):e1–8. doi:.
  6. Fournier S, Muller O, Ludman AJ, Lauriers N, Eeckhout E. Influence of socioeconomic factors on delays, management and outcome amongst patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Swiss Med Wkly. 2013;143:w13817. doi:.
  7. Stringhini S, Carmeli C, Jokela M, Avendaño M, Muennig P, Guida F, et al.; LIFEPATH consortium. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet. 2017;389(10075):1229–37. doi:.
  8. van Oeffelen AA, Agyemang C, Bots ML, Stronks K, Koopman C, van Rossem L, et al. The relation between socioeconomic status and short-term mortality after acute myocardial infarction persists in the elderly: results from a nationwide study. Eur J Epidemiol. 2012;27(8):605–13. doi:.
  9. Jakobsen L, Niemann T, Thorsgaard N, Thuesen L, Lassen JF, Jensen LO, et al. Dimensions of socioeconomic status and clinical outcome after primary percutaneous coronary intervention. Circ Cardiovasc Interv. 2012;5(5):641–8. doi:.
  10. Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M, et al. Association of socioeconomic position with health behaviors and mortality. JAMA. 2010;303(12):1159–66. doi:.
  11. Travail et rémunération, enquête suisse sur le niveau et la structure des salaires 2014. In: Confédération suisse Dfdli, Office fédéral de la statistique (ed.). Neuchâtel, Suisse: Office fédéral de la statistique service de presse; 2015.
  12. Nanchen D, Gencer B, Muller O, Auer R, Aghlmandi S, Heg D, et al. Prognosis of Patients With Familial Hypercholesterolemia After Acute Coronary Syndromes. Circulation. 2016;134(10):698–709. doi:.
  13. Vilagut G, Forero CG, Barbaglia G, Alonso J. Screening for Depression in the General Population with the Center for Epidemiologic Studies Depression (CES-D): A Systematic Review with Meta-Analysis. PLoS One. 2016;11(5):e0155431. doi:.
  14. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al.; ESC Scientific Document Group. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81. doi:.
  15. Khaing W, Vallibhakara SA, Attia J, McEvoy M, Thakkinstian A. Effects of education and income on cardiovascular outcomes: A systematic review and meta-analysis. Eur J Prev Cardiol. 2017;24(10):1032–42. doi:.
  16. Cundiff JM, Uchino BN, Smith TW, Birmingham W. Socioeconomic status and health: education and income are independent and joint predictors of ambulatory blood pressure. J Behav Med. 2015;38(1):9–16. doi:.
  17. Holtrop JS, Stommel M, Corser W, Holmes-Rovner M. Predictors of smoking cessation and relapse after hospitalization for acute coronary syndrome. J Hosp Med. 2009;4(3):E3–9. doi:.
  18. Tchicaya A, Lorentz N, Demarest S. Income-related inequality in smoking cessation among adult patients with cardiovascular disease: a 5-year follow-up of an angiography intervention in Luxembourg. BMC Cardiovasc Disord. 2017;17(1):107. doi:.
  19. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2006;60(1):7–12. doi:.
  20. Moore JC, Welniak EJ. Income Measurement Error in Surveys: A review. J Off Stat. 2000;16(4):331.

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