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The European Journal of Public Health Advance Access published online on October 26, 2006
The European Journal of Public Health, doi:10.1093/eurpub/ckl247
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© The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received March 22, 2006
Accepted September 27, 2006

Article

The role of low grade inflammation as measured by C-reactive protein levels in the explanation of socioeconomic differences in carotid atherosclerosis

M. Rosvall 1 *, G. Engström 2, L. Janzon 2, G. Berglund 2, and B. Hedblad 2

1 Department of Health Sciences, Lund University, Malmö, Sweden
2 Department of Clinical Sciences, Lund University, Malmö, Sweden

* To whom correspondence should be addressed.
M. Rosvall, E-mail: maria.rosvall{at}smi.mas.lu.se


  Abstract

Background: The role of inflammation as part of the explanation of socioeconomic differences in carotid atherosclerosis has not been specifically investigated. Methods and Results: The associations between socioeconomic position (SEP), C-reactive protein (CRP), and preclinical carotid atherosclerosis were investigated in a general population sample of 3921 middle-aged Swedish men and women. Common carotid intima-media thickness (IMT) and presence of carotid plaque (focal IMT > 1.2 mm) were determined by B-mode ultrasound. The results showed that low SEP was associated with increased levels of CRP, independently of established risk factors. Furthermore, common carotid IMT increased with increasing CRP-levels. Presence of carotid plaque increased with increasing CRP-levels in men, but not in women. While the socioeconomic differences in carotid IMT were weak, there were associations between low educational level and carotid plaque prevalence with an age- and sex-adjusted odds ratio (OR) of 1.39 (95% CI: 1.21, 1.59). A similar association was seen for having a manual occupation, OR = 1.23 (95% CI: 1.07, 1.42). The age- and sex-adjusted absolute differences in carotid plaque prevalence were 9% with regard to educational level and 7% with regard to occupational status. Adjustment for CRP caused only a minor attenuation of the association between SEP and carotid atherosclerosis. Conclusions: The association between SEP and carotid atherosclerosis as measured by carotid IMT and carotid plaque could only to a minor extent be referred to differences in low grade inflammation as measured by CRP.

Keywords: atherosclerosis; carotid arteries; c-reactive protein; socioeconomic position.
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