Social factors and cardiovascular morbidity

•Socioeconomic gradient in CHD and cardiometabolic risk factors.•Psychosocial causes of health inequalities.•Empirical study of role of smoking and other behaviors in the socioeconomic gradient in incident CVD mortality.•Findings on job stress and CHD.•Nested case-control study of autonomic, neuroendocrine and inflammatory factors as risk factors for metabolic syndrome.

Recent progress in population health at aggregate level, measured by life expectancy, has been accompanied by lack of progress in reducing the difference in health prospects between groups defined by social status. Cardiovascular disease is an important contributor to this undesirable situation. The stepwise gradient of higher risk with lower status is accounted for partly by social gradients in health behaviors. The psychosocial hypothesis provides a stronger explanation, based on social patterning of living and working environments and psychological assets that individuals develop during childhood. Three decades of research based on Whitehall II and other cohort studies provide evidence for psychosocial pathways leading to cardiovascular morbidity and mortality. Job stress is a useful paradigm because exposure is long term and depends on occupational status. Studies of social-biological translation implicate autonomic and neuroendocrine function among the biological systems that mediate between chronic adverse psychosocial exposures and increased cardiometabolic risk and cardiovascular disease incidence.