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Deprivation Can Cause Undetected Heart Problems

Heart problems may arise out of deprivation from being in poverty and poor health.

Leaving deprivation out of standard risk assessments for heart disease is potentially denying// life saving preventive treatment to those who need it most, reveals research published ahead of print in the journal Heart.

A person’s estimated chances of developing heart disease, and being allocated "primary preventive" treatment, is currently calculated using the standard risk factors of smoking, blood pressure, cholesterol, age, sex, and diabetes. These are typically pulled together in the internationally used Framingham Risk Score.

Deprivation is excluded, despite known links between poverty and poor health, because definitions of deprivation vary so much, making international standardization difficult.

The authors, from the Cardiovascular Epidemiology Unit at the University of Dundee, tracked the progress of 13,000 healthy Scottish men and women over a period of 10 years to March 1997, recording deaths and episodes of hospital treatment. All the participants were aged between 30 and 74 at the start of the study,

A new deprivation score - the Scottish Index of Multiple Deprivation (SIMD) - covering 31 indicators from income to access to services, based on areas of residence, was applied retrospectively to the data.

Using the SIMD, the authors compared "observed risk" of death/illness from heart disease with "expected risk," estimated using the Framingham score.

Expected risk showed a modest difference between the most and least deprived sectors of the study population, while observed risk revealed a very steep difference, which was fivefold in women.

The Framingham score would allocate them only half as much primary preventive treatment in proportion to their future level of disease.

The authors estimate that being in the most deprived 20% rather than the least deprived 20% is broadly equivalent to being
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