MEN Educational level High Medium Low Marital Status Married or cohabitating Other living arrangements WOMEN Educational level High Medium Low Marital Status Married or cohabitating Other living arrangements n 23 44 139 175 41 6 14 95 81 38 p/y 1473 2275 4656 7691 876 443 852 3026 3334 1126 ALL HRa (CI 95%) Ref. 1.12 (0.65;1.92) 1.06 (0.63;1.78) Ref. 3.2 (2.21;4.64) Ref. 0.77 (0.28;2.10) 1.01 (0.42;2.37) Ref. 1.15 (0.76;1.75) n 18 29 25 54 21 4 9 21 27 9 p/y 1261 1683 1717 4078 613 335 724 900 1590 431 Ref. 0.90 (0.46;1.75) 0.78 (0.41;1.49) Ref. 3.41 (1.98;5.86) Ref. 0.53 (0.13;2.09) 1.07 (0.31;3.72) Ref. 1.13 (0.50;2.54) n 5 15 114 121 20 2 5 74 54 29 NORTH HRa (CI 95%) CENTRE-SOUTH p/y HRa (CI 95%) Page 6 of 9 212 592 2939 3613 263 107 128 2126 1745 694 Ref. 1.70 (0.55;5.23) 1.72 (0.62;4.77) Ref. 2.61 (1.61;4.24) Ref. 5.75 (0.97;33.98) 1.44 (0.34;6.04) Ref. 1.15 (0.71;1.87) Fornari et al. BMC Public Health 2010, 10:574 http://www.biomedcentral.com/1471-2458/10/574 Table 5 Hazard ratio (HR) and 95% confidence intervals (CI) for cardiovascular case-fatality by social status indicators classes Men and women 35-69 years old free of previous CVD at baseline (ALL). The population is then stratified by geographical area (NORTH vs. CENTRE-SOUTH of Italy). n=number of first cardiovascular events. p/y=person-years. Ref.= reference. a HR for educational levels adjusted for age, systolic blood pressure, total cholesterol, HDL cholesterol, diabetes (yes, no), smoking habits (yes, no), anti hypertensive medication(yes, no). HR for marital status adjusted for age, systolic blood pressure, total cholesterol, HDL cholesterol, diabetes (yes, no), smoking habits (yes, no), anti hypertensive medication (yes, no), education (three levels). classes because people with low social conditions followed a poor but healthier diet, characterized by low levels of saturated fat and high levels of monounsaturated fat and fibres [34]. The Seven Countries study, started in the Six- ties by Ancel Keys et al., revealed that this nutritional regime, known as the Mediterranean diet, rich in fruits, vegetables, bread and olive oil was highly protective against death from all-cause and coronary heart disease [35]. We have few direct measures about dietary habits in our cohorts, but, according to periodical national surveys, the Mediterranean diet is diffuse in all socio-economic classes, traditionally in the South and in the Centre of the country, but, nowadays also in the North. According with the same surveys, even the prevalence of the other major risk factors (lipids, smoking and blood pressure) has demonstrated a tendency to become homogeneous during the last half century [36,37]. Data which has not yet been published referred to the 35-74 year-old population of area Brianza (Northern Italy) report an attack rate of 349.07 (x 100,000) for coronary events and 182.77 for strokes in men, 60.70 and 51.38 in women, and a mortality rate of 87.97 for coronary events and 22.96 for strokes in males and 21.95 and 18.23 in females. In Central and Southern Italy the numbers are similar i.e. a little lower but not significantly [38,39]. However, important socioeco- nomic differences persist between the north and the south of the country. The north is richer and a little more educated. In this paper, the “net” effect of two fundamen- tal social characteristics - education and marital status - on CVD risk factors, incidence and case fatality is reported and commented. Main cardiovascular risk factors (such as blood pres- sure, triglycerides, BMI, diabetes) resulted higher in less educated groups in both genders, according to the results of studies conducted in other Western countries [40]. Smoking was more prevalent in men with low edu- cational level, while the opposite tendency was detected in women. This is in agreement with other studies which revealed higher prevalence of tobacco smoking in highly educated women in Southern European countries, while the opposite was true in the Northern Europe [41]. The reason of such difference in smoking between Northern and Southern Europe is likely cultural, being an expression of the process through which the genders progress - or do not progress - to equality. No signifi- cant differences in the incidence of cardiovascular events and case-fatality by educational level were found in either gender, when all the cohorts were considered together. However when the Northern cohorts were analyzed separately, a significantly higher incidence appeared in men with a lower level of education com- pared to men with more education, making these popu- lations more similar to those of Northern Europe and confirming results reported using occupation as the