MAINTENANCE – Mortality following a heart attack and the risk of relapse in people without activity are much higher than in the rest of the population, according to a Danish study.
Overconsumption of tobacco, alcohol, sedentary lifestyle … Unemployment promotes risky behavior, and the socioeconomic factor strongly influences cardiovascular health, multiplying cardiovascular mortality by two.
But even correcting for these biases in the mortality statistics, Danish researchers at the University Hospital of Copenhagen (Denmark) estimate that the unemployed have a mortality rate of 50% higher than that of the working after a heart attack. And they are also 12% more likely to undergo at least a second hospitalization for a cardiovascular incident.
If he does not dare to explain them, the figures lead Dr Rasmus Roerth, who led the study, to compare the risk associated with being unemployed with comorbid factors such as hypertension or diabetes, and estimates that it could be taken into account in the prognosis of doctors.
The psychological factor, mental well-being, however, would play an important role. Factors which, according to Prof. Nicolas Danchin, cardiologist at the Georges Pompidou European Hospital (Paris), should be taken into account.
Do you think unemployment is a risk factor?
Prof. Nicolas Danchin: Using studies of this type is difficult because it necessarily includes a lot of bias. The medical and psychological profile of an unemployed person is different from that of an active person, and it is necessary to compensate for all these analytical biases that may exist. This is one of the important limitations of this type of study. But that does not mean that we should not be concerned with these types of questions.
Prof. Nicolas Danchin, cardiologist at the Georges Pompidou hospital
How to explain these results?
Prof. Nicolas Danchin: There are certainly several reasons that can explain this possible excess mortality. Among them, there is mental health, well-being, the patient’s experience which can certainly count, and have a role on the cardiovascular system. There is also something very silly, which we don’t necessarily think about: a person in serious economic, social and environmental difficulties will tend to take their treatment on a less regular basis. And in the treatment of heart failure, we use drugs that are extremely active and useful. So if you stop taking them, the risk increases quickly. Poor adherence is one explanation, but there are probably many others.
Should doctors take unemployment as a risk factor for the development of a disease?
Prof. Nicolas Danchin: I am not sure. First, because there is not necessarily a need to make a risk equation for all patients. It is interesting to calculate it if we can act. Doctors will not have the means to act on the unemployment of their patients. On the other hand, it is important to take into account the situation of patients in a global approach, to better support them and try to support them, to see if the psychological impact of unemployment is significant, which is often the case, and for help them understand the importance of taking their medication regularly.
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