Psychosocial factors have been shown to play an important role in the aetiology of coronary heart disease (CHD). A strong association between CHD and socioeconomic status (lower-level education, poor financial situation) has also been well established. Socioeconomic differences may thus also have an effect on psychosocial risk factors associated with CHD, and socioeconomic disadvantage may negatively affect the later prognosis and quality of life of cardiac patients. The aim of this study was to review the available evidence on socioeconomic differences in psychosocial factors which specifically contribute to CHD. A computer-aided search of the Medline and PsycINFO databases resulted in 301 articles in English published between 1994 and 2007. A comprehensive screening process identified 12 empirical studies which described the socioeconomic differences in CHD risk factors. A review of these studies showed that socioeconomic status (educational grade, occupation or income) was adversely associated with psychosocial factors linked to CHD. This association was evident in the case of hostility and depression. Available studies also showed a similar trend with respect to social support, perception of health and lack of optimism. Less consistent were the results related to anger and perceived stress levels. Socioeconomic disadvantage seems to be an important element influencing the psychosocial factors related to CHD, thus, a more comprehensive clarification of associations between these factors might be useful. More studies are needed, focused not only on well-known risk factors such as depression and hostility, but also on some lesser known psychosocial factors such as Type D and vital exhaustion and their role in CHD.

Roma coronary heart disease patients have more medical risk factors and greater severity of coronary heart disease than non-Roma Sudzinova, A.; Nagyova, Iveta; Studencan, M.; Rosenberger, Jaroslav; Skodova, Z.; Vargová, Helena; Middel, Lambertus; Reijneveld, Sijmen; van Dijk, Jitze Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Sudzinova, A., Nagyova, I., Studencan, M., Rosenberger, J., Skodova, Z., Vargova, H., ... van Dijk, J. P. (2013). Roma coronary heart disease patients have more medical risk factors and greater severity of coronary heart disease than non-Roma. International Journal of Public Health, 58(3), 409-415. DOI: 10.1007/s00038-013-0462-5 Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Abstract Objectives Coronary heart disease (CHD) is the most common cause of mortality and morbidity world-wide. Evidence on ethnic differences between the Roma and nonRoma regarding medical risk factors is scarce. The aim of this study was to assess differences in medical risk factors and the severity of CHD in Roma compared with nonRoma CHD patients, adjusted for gender, age and education. Methods Six hundred seventy four patients were included in this cross-sectional study (132 Roma, 542 non-Roma). Data on medical risk factors, symptoms, medication and severity of CHD were obtained from medical records. After matching Roma and non-Roma according to education, linear and logistic regression analyses with adjustments for gender and age were used. Results Compared with non-Roma, Roma patients had significantly more risk factors and more severe types of CHD. They were treated less frequently with statins and beta-blockers, were more frequently left on pharmacotherapy and surgically revascularised. These differences remained after controlling for education, gender and age. Conclusions Roma CHD patients have a worse risk profile at entry of care and seem to be undertreated compared with non-Roma CHD patients.

Objectives: The aim of this article is to explore socioeconomic inequalities in the psychological characteristics (psychological well-being, perceived mental health status) and perceived quality of life among cardiac patients. Methods:A structured interview was conducted with 362 patients (32 % women, mean age 56 ± 7.3 years) referred for coronary angiography. The GHQ-28 was used to measure psychological well-being, the SF-36 for perceived mental health status. Income and education indicated socioeconomic position. Logistic regressions were employed, adjusted for age, gender, functional status and severity of disease.

Low education and income seem to be strongly associated with higher vital exhaustion among patients; a significant factor contributing to worse prognosis and lower quality of life among patients with coronary heart disease.

Mortality after CAG is higher among Roma, and this is not due to differences in age, gender or education. These results warrant further reconsideration of the management of Roma cardiac patients.