title: Education, lifestyle factors and mortality from cardiovascular disease and cancer. A 25-year follow-up of Swedish 50-year-old men.
abstract: 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.
authors.affiliation: Department of Public Health and Caring Sciences/Geriatrics, PO Box 609, SE 751 25, Uppsala, Sweden. lena.kilander@geriatri.uas.lu.se
authors.forename: L
authors.initials: L
authors.lastname: Kilander
authors.forename: L
authors.initials: L
authors.lastname: Berglund
authors.forename: M
authors.initials: M
authors.lastname: Boberg
authors.forename: B
authors.initials: B
authors.lastname: Vessby
authors.forename: H
authors.initials: H
authors.lastname: Lithell
mesh_terms: D000975:Antioxidants / Q000032:analysis; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D004522:Educational Status; D015444:Exercise; D005227:Fatty Acids / Q000097:blood; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D000975:Antioxidants; D005227:Fatty Acids