regular leisure physical activity is encouraged to reduce the risk of cardiovascular disease (CVD) and mortality, but the observance of this guideline is not perfect. In parallel, the consequences of occupational-social inequalities on CVD have been well-described and persist.

To assess the potential mediating effect of leisure physical activity on the consequences of occupational status on CVD.

5683 French employed men were recruited from the cohort Prime study. Employees and manual workers were compared with white collar (chef of enterprise, intermediate staff). Hard CVD, myocardial infarction, angina, coronary death, total heart events and stroke were investigated over a 10 years follow-up. Leisure physical activity was measured using compendium physical activity. Cox analyses were used for analyzing the consequences of social inequalities on each event adjusted for classical cardiovascular risks. The propor-tion of effect was calculated to explain the potential mediating effect of leisure physical activity on the relationship between occupational social categories and CVD.

The incidence rates were respectively for: Hard CVD (2.4%), myocardial infarction (2.2%), angina (3.4%), coronary death (0.4%), total heart events (5.7%) and stroke (1.1%). Employees and manual workers have significant higher risks of hard cardiovascular events, myocardial infarction and total heart events compared with white collar, in crude analysis (HR≈1.5). Adjustments for classical cardiovascular factors reduced significantly these risks while a weak impact of leisure physical activity on the relationships between occupational categories and each event was highlighted.

The cardiovascular gradient observed between the different occupational categories is mainly explained by classical cardiovascular factors. Leisure physical activity is not sufficient by itself to compensate the occupational social inequalities.