When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood

Study objectives-To compare associations of childhood and adult socioeconom ic position with cardiovascular risk factors measured in adulthood. To esti mate the effects of adult socioeconomic position after adjustment for child hood circumstances. Design-Cross sectional survey, using the relative index of inequality metho d to compare socioeconomic differences at different life stages. Setting-The Whitehall II longitudinal study of men and women employed in Lo ndon offices of the Civil Service at study baseline in 1985-88. Participants-4774 men and 2206 women born in the period 1930-53 who were ad ministered questions on early socioeconomic circumstances. Main results-Adult occupational position (employment grade) was inversely a ssociated (high status-low risk) with current smoking and leisure time phys ical inactivity, with waist/height, and with metabolic risk factors HDL cho lesterol, triglycerides, post-load glucose and fibrinogen. Associations of these variables with childhood socioeconomic position (father's Registrar G eneral Social Class) were weaker or absent, with the exception of smoking i n women. Childhood social position was associated with adult weight in both sexes and with current smoking, waist/height, HDL cholesterol and fibrinog en in women. Height, a measure of health capital or constitution, was weakl y linked with father's social class and more strongly linked with Own emplo yment grade. The combination of childhood disadvantage (low father's class) together with a low status clerical occupation in men was particularly ass ociated with higher body mass index as an adult (interaction test p<0.001). Adjustment for earlier socioeconomic position-using father's class and own education level simultaneously-did not weaken the effects of adult socioec onomic position, except in the case of smoking in women, when the grade eff ect was reduced by 59 per cent. Conclusions-Cardiovascular risk factors in adulthood were in general more s trongly related to adult than to childhood socioeconomic position. Among wo men but not men there was a strong but unexplained link between father's cl ass and adult smoking habit. In both sexes degree of obesity was associated with both childhood and adulthood social position. These findings suggest that the socially patterned accumulation of health capital and cardiovascul ar risk begins in childhood and continues, according to socioeconomic posit ion, during adulthood.