Low education was associated with higher crude cardiovascular mortality, but this excess risk disappeared after adjusting for modifiable lifestyle factors (RR 1.01; 95% CI 0.67-1.52).
Cohort (n=2,301)
No
Do differences in traditional vascular risk factors, physical activity, and dietary biomarkers explain the association between educational level and mortality from cardiovascular disease and cancer in 50-year-old men?
Modifiable lifestyle factors and traditional cardiovascular risk factors appear to fully mediate the inverse relationship between educational level and cardiovascular mortality.
Effect estimate: RR 1.01 (95% CI 0.67-1.52)
Background There is a well-established inverse relation between education and mortality from cardiovascular disease and cancer. The reasons for this are still in part unclear. We aimed to investigate whether differences in traditional vascular risk factors, adult height, physical activity, and biomarkers of fatty acid and antioxidant intake, could explain this association. Methods In all, 2301 50-year-old men in Uppsala, Sweden (82% of the background population) were examined with regard to educational level, blood pressure, blood glucose, body mass index, serum lipids, smoking, body height, physical activity, serum beta carotene, alpha tocopherol, selenium, and serum fatty acids in cholesterol esters. Cause-specific mortality was registered 25 years later. Results Low education was associated with a higher rate of mortality from cardiovascular disease (crude relative risk RR = 1.67, 95% CI : 1.17–2.39), and from cancer (crude RR = 1.94, 95% CI : 1.21–3.10), compared to high educational attainment. Men with high education had an overall more beneficial risk factor profile concerning traditional cardiovascular risk factors, physical activity, and biomarkers of dietary intake of antioxidants and fat. After adjustment for all examined risk factors, the inverse gradient between education and cardiovascular mortality disappeared (RR in low education = 1.01. 95% CI : 0.67–1.52). Controlling for smoking, physical activity and dietary biomarkers explained less than half of the excess cancer mortality in the lower educational groups. Smoking (adjusted RR = 1.89, 95% CI : 1.37–2.61), and high proportions of palmitoleic acid in serum cholesterol esters (adjusted RR per 1 SD = 1.39, 95% CI : 1.07–1.82) predicted cancer mortality, independently of all other factors. There were no independent relations between serum antioxidants and mortality. Conclusions These data indicate that modifiable lifestyle factors mediate the inverse gradient between education and death from cerebro- and cardiovascular disease. Smoking, physical activity and dietary factors explained half of the excess cancer mortality in lower educated groups. Further studies are needed to explore the proposed association between palmitoleic acid, a marker of high intake of animal and dairy fat, and cancer.
Kilander et al. (Mon,) conducted a cohort in Cardiovascular disease and cancer (n=2,301). Low education vs. High education was evaluated on Cardiovascular mortality (adjusted for all examined risk factors) (RR 1.01, 95% CI 0.67-1.52). Low education was associated with higher crude cardiovascular mortality, but this excess risk disappeared after adjusting for modifiable lifestyle factors (RR 1.01; 95% CI 0.67-1.52).