Inequality raises a disease risk for cardiovascular diseases – especially for women

A study led by researchers at the Max Delbrück Center has found that low educational attainment and income raise the risk of cardiovascular disease in women more so than in men. The study underlines the importance of gender-specific prevention.

A growing number of studies are reporting gender differences in diseases such as stroke, heart attack and high blood pressure. “It is known from previous studies that a lower socioeconomic status is associated with a higher cardiovascular risk. The relationship between social status and the cardiovascular risk profile, and in particular whether this relationship differs between men and women, has been insufficiently researched in Germany to date,” says Professor Dr. Tobias Pischon, last author of the publication and member of the Board of Directors of NAKO e.V. The German National Cohort (NAKO) is Germany’s largest long-term study on the development of diseases.

The researchers analysed the data of 204,780 participants in the NAKO from the 2014-2019 study period. 50 per cent of the participants were women. The analysis was based on self-reported information on socioeconomic factors such as education, income and employment status, the use of antihypertensive medication, chronic cardiovascular  and metabolic conditions, lifestyle factors such as smoking and alcohol consumption as well as measured values from medical examinations at the NAKO study centres, such as blood pressure, blood test results and other measurements. The scientists took various other factors into account in the calculations.

Heart attack, high blood pressure, overweight

The study found that women with low socioeconomic status were more likely to have an adverse cardiovascular risk profile compared to a comparable group of men and women with high socioeconomic status. “In women compared with men, low socioeconomic status was more strongly associated with myocardial infarction, hypertension, obesity, use of antihypertensive medication and risky alcohol consumption, but – less strongly associated with active or former smoking,” says Dr. Ilais Moreno Velásquez, scientist at the Max Delbrück Center in Berlin-Buch and lead author of the study. In addition, compared to those with a high socioeconomic status, women with low education and income had higher odds of a high 10-year risk of cardiovascular events than men of the respective socioeconomic status

Pischon and his team plan to investigate the correlations further: “In our current evaluation, we have estimated the risk of future cardiovascular events on the basis of internationally established algorithms. With the many scientifically valuable data that we are gaining from the NAKO study through repeated examination of study participants, we will be able to check these results in the future with regard to newly diagnosed cardiovascular diseases. Overall, however, our results already indicate that the risk of cardiovascular disease in women is more strongly dependent on social status than in men. For our health policy in Germany, this underscores the importance of taking social inequalities into account in cardiovascular disease prevention strategies,” says Pischon. 

More information

Further information on the Internet
Pischon Lab Molecular Epidemiology
German Nationa Cohort (NAKO) at the Max Delbrück Center
German National Cohort data accessible for research
News MDC: NAKO aims to study how disease develops over time

Originalpublication
Moreno Velásquez I, Peters S A E, Dragano N et al. Sex Differences in the Relationship of Socioeconomic Position with Cardiovascular Disease, Cardiovascular Risk Factors, and Estimated Cardiovascular Disease Risk: Results of the German National Cohort. J Am Heart Assoc 2025. https://doi.org/10.1161/JAHA.124.038708

Contact
Dr. Ilais Moreno Velásquez
Max Delbrück Center (MDC) for Molecular Medicine
Lab Molecular Epidemiology
Robert‐Rössle‐Straße 10
13125 Berlin
ilais.morenovelasquez@mdc-berlin.de

Press contact:

Dr. Friederike Fellenberg
NAKO Gesundheitsstudie
Head of Project and Science Communication
Am Taubenfeld 21/2
69123 Heidelberg
Germany
Phone.: +49 6221 42620-62
E-mail: friederike.fellenberg@nako.de

German National Cohort (NAKO)

The German National Cohort (NAKO Gesundheitsstudie) is the largest long-term population study in Germany. Since 2014, over 205,000 randomly selected people have been medically examined and asked about their lifestyle habits in 18 study centres. At the beginning of the study, the participants were aged between 20 and 69.

The German National Cohort (NAKO) is a prospective epidemiological cohort study. The researchers observe a large group, a so-called cohort, of healthy, ill or formerly ill people over a long period of time. The aim is to use scientific analyses of the participants’ data to investigate the frequency and causes of common diseases such as cancer, diabetes or cardiovascular diseases, to identify risk factors and to show ways of effective prevention and early detection.

The research project is supported by 26 organisations. Scientists from universities, the Helmholtz Association, the Leibniz Association and other research institutes in Germany are working together in a nationwide network. The study is being carried out by the NAKO e.V. association. It is financed by public funds from the Federal Ministry of Education and Research (BMBF), the Helmholtz Association and the participating federal states.