title: Association of educational level with inflammatory markers in the Framingham Offspring Study.
abstract: Socioeconomic position consistently predicts coronary heart disease; however, the biologic mechanisms that may mediate this association are not well understood. The objective of this study was to determine whether socioeconomic position (measured as educational level) is associated with inflammatory risk factors for coronary heart disease, including C-reactive protein, interleukin-6, soluble intercellular adhesion molecule-1, monocyte chemoattractant protein-1, and P-selectin. The study sample included 2,729 participants (53.4% women; mean age, 62 +/- 10 years) from the US Framingham Offspring Study cohort who attended examination cycles 3 (1984-1987) and 7 (1998-2001) and provided educational attainment data. Inflammatory markers were measured in fasting serum samples. Multivariable linear regression analyses were performed, adjusting for potential confounders including age, sex, and clinical risk factors. In age- and sex-adjusted analyses, educational attainment was significantly inversely associated with C-reactive protein (p < 0.0001), interleukin-6 (p < 0.0001), soluble intercellular adhesion molecule-1 (p < 0.0001), and monocyte chemoattractant protein-1 (p = 0.0004). After further adjustment for clinical risk factors, educational level remained significantly associated with C-reactive protein (p = 0.0002), soluble intercellular adhesion molecule-1 (p = 0.01), and monocyte chemoattractant protein-1 (p = 0.01). In conclusion, educational attainment is associated with inflammatory risk factors for coronary heart disease. The association provides evidence suggestive of a biologic pathway by which socioeconomic position may predispose to coronary heart disease.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA. ebloucks@hsph.harvard.edu
authors.forename: Eric B
authors.initials: EB
authors.lastname: Loucks
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Sullivan
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Hayes
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Berkman
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein; D018932:Chemokine CCL2 / Q000097:blood; D003327:Coronary Disease / Q000097:blood*; D004522:Educational Status; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D012307:Risk Factors; D012923:Social Class
chemical_list: D015415:Biomarkers; D018932:Chemokine CCL2; D015850:Interleukin-6; D019007:P-Selectin; D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein