• Joaquim Barreto, Luís Carlos V Matos, José Carlos Quinaglia, Andrei C Sposito, and Luiz Sergio Carvalho.
• Atherosclerosis and Vascular Biology Laboratory (Atherolab), Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil.
• Curr Med Res Opin. 2021 Oct 1; 37 (10): 1689-1695.

BackgroundLow socioeconomic status has for long been considered an important modifiable risk factor for developing cardiovascular disease, plausibly by lower access to healthcare, lower therapeutic adhesion, and overlapping of other known risk factors. Nevertheless, whether family income and social isolation of poor communities seen in Brazil impact outcomes following ST-segment elevation myocardial infarction (STEMI) remain scarcely understood.MethodsSTEMI diagnosed patients were consecutively enrolled from the Brazilian Heart Study (ClinicalTrials.gov Identifier: NCT02062554) and categorized according to median family income (US$350), address-based human development index (HDI), and distance between communities and a tertiary hospital (DCTH). Incidence of death after 48 months was compared by using adjusted Cox regressions. p-alues < .05 were considered significant.ResultsAmong 542 subjects, there were 69 deaths (13.2%) after a median follow-up time of 611 d (IQR = 724). The low-income group had a higher incidence of all-cause mortality compared to high income (18.4 vs. 7.1%; p = .001), with an adjusted HR of 2.16 (95%CI: 1.25-3.75; p = .006). Compared to high-income, low-income individuals had the worst clinical presentation of myocardial infarction and less frequently received dual antiplatelet therapy and statins at hospital discharge. The population attributable risk of low income was 44.8%. HDI and DCTH did not influence the delay to reperfusion therapy nor the risk of death.ConclusionsLow income was independently associated with a higher long-term mortality rate, lower prescription of guidelines-recommended therapy, and worst clinical presentation of myocardial infarction in STEMI patients.

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