Roles of allostatic load, lifestyle and clinical risk factors in mediating the association between education and coronary heart disease risk in Europe
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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; Veronesi, Giovanni; Ferrario, Marco M; Forrest, Hannah; Whitehead, Margaret; Diderichsen, Finn; Tunstall-Pedoe, Hugh; Kuulasmaa, Kari; Sans, Susana; Salomaa, Veikko; Thorand, Barbara; Peters, Annette; Soderberg, Stefan; Cesana, Giancarlo; Bobak, Martin; Iacoviello, Licia; Palmieri, Luigi; Zeller, Tanja; Blankenberg, Stefan; Kee, Frank; MORGAM/BiomarCaRE consortium.
In: Journal of Epidemiology and Community Health, Vol. 75, No. 12, 2021, p. 1147-1154.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Roles of allostatic load, lifestyle and clinical risk factors in mediating the association between education and coronary heart disease risk in Europe
AU - Hicks, Blánaid
AU - Veronesi, Giovanni
AU - Ferrario, Marco M
AU - Forrest, Hannah
AU - Whitehead, Margaret
AU - Diderichsen, Finn
AU - Tunstall-Pedoe, Hugh
AU - Kuulasmaa, Kari
AU - Sans, Susana
AU - Salomaa, Veikko
AU - Thorand, Barbara
AU - Peters, Annette
AU - Soderberg, Stefan
AU - Cesana, Giancarlo
AU - Bobak, Martin
AU - Iacoviello, Licia
AU - Palmieri, Luigi
AU - Zeller, Tanja
AU - Blankenberg, Stefan
AU - Kee, Frank
AU - MORGAM/BiomarCaRE consortium
N1 - © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
U2 - 10.1136/jech-2020-215394
DO - 10.1136/jech-2020-215394
M3 - Journal article
C2 - 34049926
VL - 75
SP - 1147
EP - 1154
JO - Journal of Epidemiology & Community Health
JF - Journal of Epidemiology & Community Health
SN - 0143-005X
IS - 12
ER -
ID: 270355744