title: Persistent pathogens linking socioeconomic position and cardiovascular disease in the US.
abstract: BACKGROUND
  Numerous studies have documented a strong inverse association between cardiovascular disease and socioeconomic position (SEP). Several infections are associated with both cardiovascular disease and SEP; hence infection may form an important link between SEP and cardiovascular disease. This study examines whether seropositivity to cytomegalovirus (CMV), to herpes simplex virus type-1 (HSV-1), and/or to both pathogens mediates the relationship between SEP and cardiovascular disease history in a nationally representative sample of the United States.
  
  
  METHODS
  We conducted a cross-sectional study of subjects > or =45 years of age, who were tested for seropositivity to CMV, HSV-1 or both pathogens and assessed for cardiovascular disease history in the National Health and Nutrition Examination Survey III. Cardiovascular disease history was defined as history of stroke, heart attack and/or congestive heart failure and SEP as education level.
  
  
  RESULTS
  SEP was associated with CMV, HSV-1 and seropositivity to both pathogens. CMV seropositivity was associated with cardiovascular disease history even after adjusting for confounders as well as SEP. The odds of reporting a history of cardiovascular disease for those with less than a high school education compared with those with more than a high school education decreased by 7.7% after adjusting for CMV (Sobel mediation test for CMV, P = 0.0006). In contrast, neither seropositivity to HSV-1 nor to both pathogens was associated with cardiovascular disease history after adjusting for SEP.
  
  
  CONCLUSIONS
  Persistent pathogens such as CMV infection may explain a portion of the relationship between SEP and cardiovascular disease in the United States. Further studies examining additional pathogens and sociobiological mechanisms are warranted.
authors.affiliation: Center for Social Epidemiology & Population Health School of Public Health-University of Michigan, Ann Arbor, MI 48109-2029, USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Simanek
authors.forename: Jennifer Beam
authors.initials: JB
authors.lastname: Dowd
authors.forename: Allison E
authors.initials: AE
authors.lastname: Aiello
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003586:Cytomegalovirus Infections / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006561:Herpes Simplex / Q000097:blood / Q000453:epidemiology*; D018259:Herpesvirus 1, Human; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology