The role of preclinical atherosclerosis in the explanation of educational differences in incidence of coronary events.

Maria Rosvall, Gunnar Engström, Bo Hedblad, Lars Janzon, Göran Berglund

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Abstract

The associations between educational level, preclinical carotid atherosclerosis and incident coronary events (CE), were investigated in a general population sample of 5399 Swedish middle-aged men and women without history of cardiovascular disease (CVD) over a median follow-up of 8.7 years. Presence of carotid plaque (focal intima-media thickness (IMT) >1.2 mm) was determined by B-mode ultrasound. In the age- and sex-adjusted model, there was an inverse relationship between educational level and risk of future CE (p for trend = 0.002). To explore if there were education differences between groups with similar degrees of preclinical carotid atherosclerosis stratified analyses were made. Those with low educational level without carotid plaque showed a slightly increased hazard rate ratio (HRR), 1.14 (95% CI: 0.65, 1.97), compared to those with high educational level without carotid plaque (reference group). For those with high educational level with carotid plaque the HRR was 1.53 (95% CI: 0.92, 2.55). Having both low educational level and carotid plaque was associated with a HRR of 2.72 (95% CI: 1.72, 4.31). Individuals with plaque generally had more unfavourable cardiovascular risk factor levels, regardless of educational level. However, after risk factor adjustment those with both low education and carotid plaque still had a two-fold increased risk of CE. The results imply that differences in the prevalence of preclinical atherosclerosis seem important in explaining education differences in future coronary morbidity.
Original languageEnglish
Pages (from-to)251-256
JournalAtherosclerosis
Volume187
Issue number2
DOIs
Publication statusPublished - 2006

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Keywords

  • Incidence
  • Coronary disease
  • Atherosclerosis
  • Carotid arteries
  • Socioeconomic factors
  • Ultrasound

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