title: The role of preclinical atherosclerosis in the explanation of educational differences in incidence of coronary events.
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) >1.2mm) 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.
authors.affiliation: Department of Community Medicine, University Hospital, SE-205 02 Malmö, Sweden. maria.rosvall@smi.mas.lu.se
authors.forename: Maria
authors.initials: M
authors.lastname: Rosvall
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.forename: Lars
authors.initials: L
authors.lastname: Janzon
authors.forename: Berglund
authors.initials: B
authors.lastname: Göran
mesh_terms: D017677:Age Distribution; D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D014463:Ultrasonography