Socioeconomic status, cardiovascular risk factors and coronary atherosclerosis: a SCOT-HEART trial analysis

Jonathan R Weir-McCall; Ryan Wereski; Jian Chen; Jin Zheng; Jacek Kwiecinski; Philip D Adamson; Nicholas L Mills; Evangelos Tzolos; Colin Berry; Giles Roditi; Edwin J R van Beek; Leslee J Shaw; Edward D Nicol; Daniel S Berman; Piotr J Slomka; Marc R Dweck; Damini Dey; Ahmed A Tawakol; David E Newby; Michelle C Williams

doi:10.1093/eurjpc/zwaf121

Socioeconomic status, cardiovascular risk factors and coronary atherosclerosis: a SCOT-HEART trial analysis

Jonathan R Weir-McCall, Ryan Wereski, Jian Chen, Jin Zheng, Jacek Kwiecinski, Philip D Adamson, Nicholas L Mills, Evangelos Tzolos, Colin Berry, Giles Roditi, Edwin J R van Beek, Leslee J Shaw, Edward D Nicol, Daniel S Berman, Piotr J Slomka, Marc R Dweck, Damini Dey, Ahmed A Tawakol, David E Newby, Michelle C Williams

Research output: Contribution to journal › Article › peer-review

Abstract

AIMS: To investigate the relationship between socioeconomic status, plaque burden on coronary computed tomography angiography (CCTA), management and outcomes.

METHODS: In a post-hoc analysis of a multicentre randomised control trial, we assessed associations between socioeconomic status and qualitative (stenosis, adverse plaque characteristics) and quantitative (total plaque, calcified plaque, non-calcified and low attenuation) CCTA plaque features and examined the interaction of socioeconomic status on cardiovascular outcomes.

RESULTS: Socioeconomic status was available in 3948 participants of whom 1989 were randomised to CCTA and 1629 scans were suitable and available for quantitative plaque analysis. Within these 1629 participants, 15% were from the lowest socioeconomic quintile and 25% from the highest socioeconomic quintile. Participants in the most deprived socioeconomic group were younger, had lower cardiovascular risk, and less likely to have severe stenosis or multivessel disease. After adjustment for cardiovascular risk factors, there was no difference in quantitative plaque burden between socioeconomic groups. After a median of 4.75 years follow-up, CTCA-guided management was associated with similar changes in medical therapy, and similar reductions in the risk of coronary heart disease death, or non-fatal myocardial infarction in low and high socioeconomic groups, with no difference between the base and interaction models (p=0.35).

CONCLUSION: Socioeconomic status is not an independent predictor of coronary artery disease severity, rather, the association is mostly determined by modifiable risk factors. Preventive therapies, guided by CCTA, achieves similar benefits in both low and high socioeconomic status individuals.

Original language	English
Journal	European Journal of Preventive Cardiology
Early online date	5 Mar 2025
DOIs	https://doi.org/10.1093/eurjpc/zwaf121
Publication status	E-pub ahead of print - 5 Mar 2025

Keywords / Materials (for Non-textual outputs)

Computed tomography angiography
coronary artery disease
quantitative plaque assessment
pericoronary adipose tissue
risk stratification

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10.1093/eurjpc/zwaf121

Socioeconomic status, cardiovascular risk factors and coronary atherosclerosis a SCOT-HEART trial analysisAccepted author manuscript, 1.1 MBLicence: Creative Commons: Attribution (CC-BY)

2 Active
9 Finished

Incidental coronary calcification on thoracic computed tomography
Williams, M. (Principal Investigator), Mills, N. (Co-investigator) & Newby, D. (Co-investigator)
UK-based charities
1/02/21 → 31/01/26
Project: Research
High-Sensitivity Cardiac Troponin Beyond the Acute Coronary Syndrome
Mills, N. (Principal Investigator), Anand, A. (Co-investigator), Chapman, A. (Co-investigator), Ferry, A. (Co-investigator), Newby, D. (Co-investigator), Strachan, F. (Co-investigator) & Tsanas, T. (Co-investigator)
UK-based charities
1/06/20 → 31/05/25
Project: Research
6th Preclinical Stroke Symposium
Horsburgh, K. (Principal Investigator), Fowler, J. (Co-investigator), McColl, B. (Co-investigator) & McCulloch, L. (Co-investigator)
British Heart Foundation
4/09/23 → 5/09/23
Project: Research

Cite this

Weir-McCall, J. R., Wereski, R., Chen, J., Zheng, J., Kwiecinski, J., Adamson, P. D., Mills, N. L., Tzolos, E., Berry, C., Roditi, G., van Beek, E. J. R., Shaw, L. J., Nicol, E. D., Berman, D. S., Slomka, P. J., Dweck, M. R., Dey, D., Tawakol, A. A., Newby, D. E., & Williams, M. C. (2025). Socioeconomic status, cardiovascular risk factors and coronary atherosclerosis: a SCOT-HEART trial analysis. European Journal of Preventive Cardiology. Advance online publication. https://doi.org/10.1093/eurjpc/zwaf121

@article{48e2d6ffef9d44ec827c2eec50fa7b87,

title = "Socioeconomic status, cardiovascular risk factors and coronary atherosclerosis: a SCOT-HEART trial analysis",

abstract = "AIMS: To investigate the relationship between socioeconomic status, plaque burden on coronary computed tomography angiography (CCTA), management and outcomes.METHODS: In a post-hoc analysis of a multicentre randomised control trial, we assessed associations between socioeconomic status and qualitative (stenosis, adverse plaque characteristics) and quantitative (total plaque, calcified plaque, non-calcified and low attenuation) CCTA plaque features and examined the interaction of socioeconomic status on cardiovascular outcomes.RESULTS: Socioeconomic status was available in 3948 participants of whom 1989 were randomised to CCTA and 1629 scans were suitable and available for quantitative plaque analysis. Within these 1629 participants, 15% were from the lowest socioeconomic quintile and 25% from the highest socioeconomic quintile. Participants in the most deprived socioeconomic group were younger, had lower cardiovascular risk, and less likely to have severe stenosis or multivessel disease. After adjustment for cardiovascular risk factors, there was no difference in quantitative plaque burden between socioeconomic groups. After a median of 4.75 years follow-up, CTCA-guided management was associated with similar changes in medical therapy, and similar reductions in the risk of coronary heart disease death, or non-fatal myocardial infarction in low and high socioeconomic groups, with no difference between the base and interaction models (p=0.35).CONCLUSION: Socioeconomic status is not an independent predictor of coronary artery disease severity, rather, the association is mostly determined by modifiable risk factors. Preventive therapies, guided by CCTA, achieves similar benefits in both low and high socioeconomic status individuals.",

keywords = "Computed tomography angiography, coronary artery disease, quantitative plaque assessment, pericoronary adipose tissue, risk stratification",

author = "Weir-McCall, {Jonathan R} and Ryan Wereski and Jian Chen and Jin Zheng and Jacek Kwiecinski and Adamson, {Philip D} and Mills, {Nicholas L} and Evangelos Tzolos and Colin Berry and Giles Roditi and {van Beek}, {Edwin J R} and Shaw, {Leslee J} and Nicol, {Edward D} and Berman, {Daniel S} and Slomka, {Piotr J} and Dweck, {Marc R} and Damini Dey and Tawakol, {Ahmed A} and Newby, {David E} and Williams, {Michelle C}",

note = "{\textcopyright} The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].",

year = "2025",

month = mar,

day = "5",

doi = "10.1093/eurjpc/zwaf121",

language = "English",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

publisher = "Oxford University Press",

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Weir-McCall, JR, Wereski, R, Chen, J, Zheng, J, Kwiecinski, J, Adamson, PD, Mills, NL, Tzolos, E, Berry, C, Roditi, G, van Beek, EJR, Shaw, LJ, Nicol, ED, Berman, DS, Slomka, PJ, Dweck, MR, Dey, D, Tawakol, AA, Newby, DE & Williams, MC 2025, 'Socioeconomic status, cardiovascular risk factors and coronary atherosclerosis: a SCOT-HEART trial analysis', European Journal of Preventive Cardiology. https://doi.org/10.1093/eurjpc/zwaf121

TY - JOUR

T1 - Socioeconomic status, cardiovascular risk factors and coronary atherosclerosis

T2 - a SCOT-HEART trial analysis

AU - Weir-McCall, Jonathan R

AU - Wereski, Ryan

AU - Chen, Jian

AU - Zheng, Jin

AU - Kwiecinski, Jacek

AU - Adamson, Philip D

AU - Mills, Nicholas L

AU - Tzolos, Evangelos

AU - Berry, Colin

AU - Roditi, Giles

AU - van Beek, Edwin J R

AU - Shaw, Leslee J

AU - Nicol, Edward D

AU - Berman, Daniel S

AU - Slomka, Piotr J

AU - Dweck, Marc R

AU - Dey, Damini

AU - Tawakol, Ahmed A

AU - Newby, David E

AU - Williams, Michelle C

N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

PY - 2025/3/5

Y1 - 2025/3/5

N2 - AIMS: To investigate the relationship between socioeconomic status, plaque burden on coronary computed tomography angiography (CCTA), management and outcomes.METHODS: In a post-hoc analysis of a multicentre randomised control trial, we assessed associations between socioeconomic status and qualitative (stenosis, adverse plaque characteristics) and quantitative (total plaque, calcified plaque, non-calcified and low attenuation) CCTA plaque features and examined the interaction of socioeconomic status on cardiovascular outcomes.RESULTS: Socioeconomic status was available in 3948 participants of whom 1989 were randomised to CCTA and 1629 scans were suitable and available for quantitative plaque analysis. Within these 1629 participants, 15% were from the lowest socioeconomic quintile and 25% from the highest socioeconomic quintile. Participants in the most deprived socioeconomic group were younger, had lower cardiovascular risk, and less likely to have severe stenosis or multivessel disease. After adjustment for cardiovascular risk factors, there was no difference in quantitative plaque burden between socioeconomic groups. After a median of 4.75 years follow-up, CTCA-guided management was associated with similar changes in medical therapy, and similar reductions in the risk of coronary heart disease death, or non-fatal myocardial infarction in low and high socioeconomic groups, with no difference between the base and interaction models (p=0.35).CONCLUSION: Socioeconomic status is not an independent predictor of coronary artery disease severity, rather, the association is mostly determined by modifiable risk factors. Preventive therapies, guided by CCTA, achieves similar benefits in both low and high socioeconomic status individuals.

AB - AIMS: To investigate the relationship between socioeconomic status, plaque burden on coronary computed tomography angiography (CCTA), management and outcomes.METHODS: In a post-hoc analysis of a multicentre randomised control trial, we assessed associations between socioeconomic status and qualitative (stenosis, adverse plaque characteristics) and quantitative (total plaque, calcified plaque, non-calcified and low attenuation) CCTA plaque features and examined the interaction of socioeconomic status on cardiovascular outcomes.RESULTS: Socioeconomic status was available in 3948 participants of whom 1989 were randomised to CCTA and 1629 scans were suitable and available for quantitative plaque analysis. Within these 1629 participants, 15% were from the lowest socioeconomic quintile and 25% from the highest socioeconomic quintile. Participants in the most deprived socioeconomic group were younger, had lower cardiovascular risk, and less likely to have severe stenosis or multivessel disease. After adjustment for cardiovascular risk factors, there was no difference in quantitative plaque burden between socioeconomic groups. After a median of 4.75 years follow-up, CTCA-guided management was associated with similar changes in medical therapy, and similar reductions in the risk of coronary heart disease death, or non-fatal myocardial infarction in low and high socioeconomic groups, with no difference between the base and interaction models (p=0.35).CONCLUSION: Socioeconomic status is not an independent predictor of coronary artery disease severity, rather, the association is mostly determined by modifiable risk factors. Preventive therapies, guided by CCTA, achieves similar benefits in both low and high socioeconomic status individuals.

KW - Computed tomography angiography

KW - coronary artery disease

KW - quantitative plaque assessment

KW - pericoronary adipose tissue

KW - risk stratification

U2 - 10.1093/eurjpc/zwaf121

DO - 10.1093/eurjpc/zwaf121

M3 - Article

C2 - 40038072

SN - 2047-4873

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

ER -

Socioeconomic status, cardiovascular risk factors and coronary atherosclerosis: a SCOT-HEART trial analysis

Abstract

Keywords / Materials (for Non-textual outputs)

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Projects

Incidental coronary calcification on thoracic computed tomography

High-Sensitivity Cardiac Troponin Beyond the Acute Coronary Syndrome

6th Preclinical Stroke Symposium

Cite this