The educational gradient in coronary heart disease: the association with cognition in a cohort of 57,279 male conscripts.
BACKGROUND
Independently of cardiovascular disease (CVD) risk factors, cognitive ability may account for some of the excess risk of coronary heart disease (CHD) associated with lower education. We aimed to assess how late adolescence cognitive ability and midlife CVD risk factors are associated with the educational gradient in CHD in Norway.


METHODS
In a cohort of 57 279 men born during 1949-1959, health survey information was linked to military conscription records of cognitive ability, to national educational data, to hospitalisation records from the Cardiovascular Disease in Norway (CVDNOR) project and to the Norwegian Cause of Death Registry.


RESULTS
Age and period adjusted HR for incident CHD events was 3.62 (95% CI 2.50 to 5.24) for basic relative to tertiary education, and was attenuated after adjustment; to 2.86 (1.87 to 4.38) for cognitive ability, to 1.90 (1.30 to 2.78) for CVD risk factors, and to 1.84 (1.20 to 2.83) when adjusting for both. Age and period adjusted absolute rate difference was 51 (33 to 70) incident CHD events per 100,000 person years between basic and tertiary educated, and was attenuated after adjustment; to 42 (22 to 61) for cognitive ability, to 25 (7 to 42) for CVD risk factors, and to 24 (5 to 43) when adjusting for both.


CONCLUSIONS
Late adolescence cognitive ability attenuated the educational gradient in incident CHD events. CVD risk factors further attenuated the gradient, and to the same extent regardless of whether cognitive ability was included or not. Cognitive ability might be linked to the educational gradient through CVD risk factors.
Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
Inger
I
Ariansen
Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.
Laust
L
Mortensen
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Jannicke
J
Igland
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Department of Heart Disease, Norwegian Institute of Public Health, Bergen, Norway.
Grethe S
GS
Tell
Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
Kristian
K
Tambs
Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
Sidsel
S
Graff-Iversen
Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway.
Bjørn Heine
BH
Strand
Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway.
Øyvind
Ø
Næss
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D003071:Cognition; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology*; D004522:Educational Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007361:Intelligence Tests / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D009664:Norway / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D057185:Sedentary Behavior; D012907:Smoking / Q000453:epidemiology
CHD/CORONORARY HEART; COGNITION; EDUCATION; Health inequalities