***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — Persons of lower socioeconomic status have greater cardiovascular risk than those of higher socioeconomic status . However , the mechanism through which socioeconomic status affects cardiovascular disease ( CVD ) is uncertain . Virtually no data are available that examine the prospect i ve association between novel inflammatory and hemostatic CVD risk indicators , socioeconomic status , and incident CVD events . Methods and Results — We assessed the relationship between 2 indicators of socioeconomic status ( education and income ) , traditional and novel CVD risk factors ( high sensitivity C-reactive protein , soluble intercellular adhesion molecule-1 , fibrinogen , and homocysteine ) , and incident CVD events among 22 688 apparently healthy female health professionals participating in the Women 's Health Study . These women were followed up for 10 years for the development of myocardial infa rct ion , ischemic stroke , coronary revascularization , and cardiovascular death . More educated women were less likely to be smokers ; had a lower prevalence of hypertension , diabetes , and obesity ; and were more likely to participate in vigorous physical activity than less educated women . At baseline , median total cholesterol , low-density lipoprotein , triglyceride , C-reactive protein , intercellular adhesion molecule-1 , fibrinogen , and homocysteine levels for women in 5 categories of education ( < 2 years of nursing education , 2 to < 4 years of nursing education , a bachelor 's degree , a master 's degree , and a doctoral degree ) and 6 categories of income [ ≤$19 999 , $ 20 000 to $ 29 999 , $ 30 000 to $ 39 999 , $ 40 000 to $ 49 999 , $ 50 000 to $ 99 999 , and ≥$100 000 ) decreased progressively with increasing education or income levels ( all P<0.001 ) , whereas an opposite pattern was observed for high-density lipoprotein ( P<0.001 ) . Overall , in age-adjusted Cox proportional hazards models , the relative risk of incident CVD events decreased with increasing education ( 1.0 , 0.7 , 0.5 , 0.4 , and 0.5 ; P for trend < 0.001 ) and income ( 1.0 , 1.0 , 0.9 , 0.7 , 0.6 , and 0.4 ; P for trend < 0.001 ) categories . In multivariate models that assessed the impact of traditional and novel CVD risk factors on the relationship between education/income and CVD events , the relative hazard of incident CVD associated with a 1-category-higher level of education changed from 0.79 in age- and race-adjusted analysis to 0.89 in fully adjusted analysis . The 11 % lower risk per 1 category of education remained significant ( P for trend=0.006 ) , suggesting that controlling for both novel and traditional risk factors could not explain the protective effect of education . A similar analysis for income revealed that its relationship with CVD events was explained largely by these noted risk factors . Conclusions — In this prospect i ve analysis , we observed a decrease in incident CVD events with increasing levels of education and income . In contrast to the relationship between income and CVD events , the relationship of CVD events with education was explained only partially by traditional and novel risk factors for CVD Importance Increased left ventricular ( LV ) mass and diastolic dysfunction are associated with cardiovascular disease . Prospect i ve data on effects of childhood socioeconomic status ( SES ) on measures of LV structure and function are lacking . Objective To examine whether family SES in childhood was associated with LV mass and diastolic function after adjustment for conventional cardiovascular disease risk factors in childhood and adulthood . Design , Setting , and Participants The analyses were performed in 2016 using data gathered in 1980 and 2011 within the longitudinal population -based Cardiovascular Risk in Young Finns Study . The sample comprised 1871 participants who reported family SES at ages 3 to 18 years and were evaluated for LV structure and function 31 years later . Exposures Socioeconomic status was characterized as annual income of the family and classified on a 3-point scale . Main Outcomes and Measures Left ventricular mass indexed according to height at the allometric power of 2.7 and the E/e′ ratio describing LV diastolic performance at ages 34 to 49 years . Results The participants were aged 3 to 18 years at baseline ( mean [ SD ] , 10.8 [ 5.0 ] years ) , and the length of follow-up was 31 years . Family SES was inversely associated with LV mass ( mean [ SD ] LV mass index , 31.8 [ 6.7 ] , 31.0 [ 6.6 ] , and 30.1 [ 6.4 ] g/m2.7 in the low , medium , and high SES groups , respectively ; differences [ 95 % CI ] , 1.7 [ 0.6 to 2.8 ] for low vs high SES ; 0.8 [ −0.3 to 1.9 ] for low vs medium ; and 0.9 [ 0.1 to 1.6 ] for medium vs high ; overall P = .001 ) and E/e′ ratio ( mean [ SD ] E/e′ ratio , 5.0 [ 1.0 ] , 4.9 [ 1.0 ] , and 4.7 [ 1.0 ] in the low , medium , and high SES groups , respectively ; differences [ 95 % CI ] , 0.3 [ 0.1 to 0.4 ] for low vs high SES ; 0.1 [ −0.1 to 0.3 ] for low vs medium ; and 0.2 [ 0 to 0.3 ] for medium vs high ; overall P < .001 ) in adulthood . After adjustment for age , sex , and conventional cardiovascular disease risk factors in childhood and adulthood , and participants ’ own SES in adulthood , the relationship with LV mass ( differences [ 95 % CI ] , 1.5 [ 0.2 to 2.8 ] for low vs high SES ; 1.3 [ 0 to 2.6 ] for low vs medium ; and 0.2 [ −0.6 to 1.0 ] for medium vs high ; P = .03 ) and E/e′ ratio ( differences [ 95 % CI ] , 0.2 [ 0 to 0.5 ] for low vs high SES ; 0.1 [ −0.1 to 0.4 ] for low vs medium ; and 0.1 [ 0 to 0.3 ] for medium vs high ; P = .02 ) remained significant . Conclusions and Relevance Low family SES was associated with increased LV mass and impaired diastolic performance more than 3 decades later . These findings emphasize that approaches of cardiovascular disease prevention must be directed also to the family environment of the developing child BACKGROUND The incidence of congestive heart failure ( CHF ) has been increasing steadily in the United States during the past 2 decades . We studied risk factors for CHF and their corresponding attributable risk in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study . PARTICIPANTS AND METHODS A total of 13 643 men and women without a history of CHF at baseline examination were included in this prospect i ve cohort study . Risk factors were measured using st and ard methods between 1971 and 1975 . Incidence of CHF was assessed using medical records and death certificates obtained between 1982 and 1984 and in 1986 , 1987 , and 1992 . RESULTS During average follow-up of 19 years , 1382 CHF cases were documented . Incidence of CHF was positively and significantly associated with male sex ( relative risk [ RR ] , 1.24 ; 95 % confidence interval [ CI ] , 1.10 - 1.39 ; P<.001 ; population attributable risk [ PAR ] , 8.9 % ) , less than a high school education ( RR , 1.22 ; 95 % CI , 1.04 - 1.42 ; P = .01 ; PAR , 8.9 % ) , low physical activity ( RR , 1.23 ; 95 % CI , 1.09 - 1.38 ; P<.001 ; PAR , 9.2 % ) , cigarette smoking ( RR , 1.59 ; 95 % CI , 1.39 - 1.83 ; P<.001 ; PAR , 17.1 % ) , overweight ( RR , 1.30 ; 95 % CI , 1.12 - 1.52 ; P = .001 ; PAR , 8.0 % ) , hypertension ( RR , 1.40 ; 95 % CI , 1.24 - 1.59 ; P<.001 ; PAR , 10.1 % ) , diabetes ( RR , 1.85 ; 95 % CI , 1.51 - 2.28 ; P<.001 ; PAR , 3.1 % ) , valvular heart disease ( RR , 1.46 ; 95 % CI , 1.17 - 1.82 ; P = .001 ; PAR , 2.2 % ) , and coronary heart disease ( RR , 8.11 ; 95 % CI , 6.95 - 9.46 ; P<.001 ; PAR , 61.6 % ) . CONCLUSIONS Male sex , less education , physical inactivity , cigarette smoking , overweight , diabetes , hypertension , valvular heart disease , and coronary heart disease are all independent risk factors for CHF . More than 60 % of the CHF that occurs in the US general population might be attributable to coronary heart disease Objective To investigate the association between low functional health literacy ( ability to read and underst and basic health related information ) and mortality  in older adults . Design Population based longitudinal cohort study based on a stratified r and om sample of households . Setting Engl and . Participants 7857 adults aged 52 or more who participated in the second wave ( 2004 - 5 ) of the English Longitudinal Study of Ageing and survived more than 12 months after interview . Participants completed a brief four item test of functional health literacy  , which assessed underst and ing of written instructions for taking an aspirin tablet . Main outcome measure Time to death , based on all cause mortality through October 2009 . Results Health literacy was categorised as high ( maximum score , 67.2 % ) , medium ( one error , 20.3 % ) , or low ( more than one error , 12.5 % ) . During follow-up ( mean 5.3 years ) 621 deaths occurred : 321 ( 6.1 % ) in the high health literacy category , 143 ( 9.0 % ) in the medium category , and 157 ( 16.0 % ) in the low category . After adjusting for personal characteristics , socioeconomic position , baseline health , and health behaviours , the hazard ratio for all cause mortality for participants with low health literacy was 1.40 ( 95 % confidence interval 1.15 to 1.72 ) and with medium health literacy was 1.15 ( 0.94 to 1.41 ) compared with participants with high health literacy . Further adjustment for cognitive ability reduced the hazard ratio for low health literacy to 1.26 ( 1.02 to 1.55 ) . Conclusions A third of older adults in Engl and have difficulties reading and underst and ing basic health related written information . Poorer underst and ing is associated with higher mortality . The limited health literacy capabilities within this population have implication s for the design and delivery of health related services for older adults in Engl and A process to identify and target a selected population at risk of heart failure ( HF ) could facilitate screening and prevention . We sought to develop an effective screening process from clinical characteristics , functional capacity , and electrocardiogram ( ECG ) . Asymptomatic subjects ≥65 years , with ≥1 HF risks were recruited from the community . Subjects with valvular disease , ejection fraction < 40 % , and atrial fibrillation were excluded . All underwent clinical evaluation including assessment of HF risk using Framingham HF score and Atherosclerosis Risk in Communities ( ARIC ) score , ECG , echocardiography , and 6-minute walk ( 6 MW ) test . After 14 ± 4 months , new HF was assessed using Framingham criteria . A r and omly selected derivation cohort was used to integrate ARIC score and 6 MW in a classification and regression tree ( CART ) analysis , with the remaining population used for validation . Of the 419 subjects ( age 70 ± 5 ; 48 % men ) , 52 developed  HF . ARIC was more effective than the Framingham HF score ( area under the curve 0.65 vs 0.53 , p = 0.01 ) . CART selected ARIC ( > 9.5 % ) and 6 MW ( < 501 m ) as cutoffs to define low- , intermediate- , and high-risk groups . Abnormal ECG further divided the intermediate group into high and low risks . The 134 subjects identified as high risk by a combined clinical and electrocardiographic strategy showed more echocardiographic features of cardiac dysfunction including LV mass , mitral e ' , mitral E/e ' , and longitudinal strain ( p < 0.01 ) . New HF was significantly more frequent than in the remaining 
    Output:
    
Low SES assessed by all common measures confers independent risk for incident HF .