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Roles of allostatic load, lifestyle and clinical risk factors in mediating the association between education and coronary heart disease risk in Europe

Hicks, Blánaid (author)
Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
Veronesi, Giovanni (author)
Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
Ferrario, Marco M. (author)
Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Forrest, Hannah (author)
Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
Whitehead, Margaret (author)
Department of Public Health and Policy, Institute of Population Health and Sciences, University of Liverpool, Liverpool, United Kingdom
Diderichsen, Finn (author)
Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Tunstall-Pedoe, Hugh (author)
Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom
Kuulasmaa, Kari (author)
Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
Sans, Susana (author)
Catalan Department of Health, Barcelona, Spain
Salomaa, Veikko (author)
Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
Thorand, Barbara (author)
Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
Peters, Annette (author)
Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
Söderberg, Stefan (author)
Umeå universitet,Avdelningen för medicin
Cesana, Giancarlo (author)
Research Centre on Public Health, Department of Medicine and Surgery, University of Milan–Bicocca, Monza, Italy
Bobak, Martin (author)
Department of Epidemiology and Public Health, University College London, London, United Kingdom
Iacoviello, Licia (author)
Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
Palmieri, Luigi (author)
Department of Cardiovascular, Endocrine-Metabolic Diseases, and Ageing, National Institute of Health, Roma, Lazio, Italy
Zeller, Tanja (author)
Department of Cardiology, University Heart and Vascular Centre, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Blankenberg, Stefan (author)
Department of Cardiology, University Heart and Vascular Centre, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Kee, Frank (author)
Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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 (creator_code:org_t)
2021-05-28
2021
English.
In: Journal of Epidemiology and Community Health. - : BMJ Publishing Group Ltd. - 0143-005X .- 1470-2738. ; 75:12, s. 1147-1154
Related links:
https://doi.org/10.1...
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https://umu.diva-por... (primary) (Raw object)
https://jech.bmj.com...
https://urn.kb.se/re...
https://doi.org/10.1...
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Background: Previous studies have shown that differential exposure to lifestyle factors may mediate the association between education and coronary heart diseases (CHD). However, few studies have examined the potential roles of allostatic load (AL) or differential susceptibility.Methods: 25 310 men and 26 018 women aged 35–74 and CHD free at baseline were identified from 21 European cohorts and followed for a median of 10 years, to investigate the mediating role of AL, as well as of smoking, alcohol use and body mass index (BMI), on educational differences in CHD incidence, applying marginal structural models and three-way decomposition.Results: AL is a mediator of the association between educational status and CHD incidence, with the highest proportion mediated observed among women and largely attributable to differential exposure, (28% (95% CI 19% to 44%)), with 8% (95% CI 0% to 16%) attributable to differential susceptibility. The mediating effects of smoking, alcohol and BMI, compared with AL, were relatively small for both men and women.Conclusion: Overall, the educational inequalities in CHD incidence were partially mediated through differential exposure to AL. By contrast, the mediation of the educational gradient in CHD by investigated lifestyle risk factors was limited. As differential susceptibility in men was found to have a predominant role in the accumulation of AL in low educational classes, the investigation of AL-related risk factors is warranted.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

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