Wamala S P, Murray M A, Horsten M, Eriksson M, Schenck-Gustafsson K, Hamsten A, Silveira A, Orth-Gomér K
Department of Public Health Sciences, Division of Preventive Medicine, Karolinska Institute, Stockholm, Sweden.
Arterioscler Thromb Vasc Biol. 1999 Mar;19(3):485-92. doi: 10.1161/01.atv.19.3.485.
Hemostatic factors are reported to be associated with coronary heart disease (CHD). Socioeconomic status (SES) is 1 of the determinants of the hemostatic profile, but the factors underlying this association are not well known. Our aim was to examine determinants of the socioeconomic differences in hemostatic profile. Between 1991 and 1994, we studied 300 healthy women, aged 30 to 65 years, who were representative of women living in the greater Stockholm area. Fibrinogen, factor VII mass concentration (FVII:Ag), activated factor VII (FVIIa), von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1) were measured. Educational attainment was used as a measure of SES. Low educational level and an unfavorable hemostatic profile were both associated with older age, unhealthful life style, psychosocial stress, atherogenic biochemical factors, and hypertension. Levels of hemostatic factors increased with lower educational attainment. Independently of age, the differences between the lowest (mandatory) and highest (college/university) education in FVII:Ag levels were 41 microg/L (95% confidence interval [CI], 15 to 66 microg/L, P=0.001), 0.26 g/L (95% CI, 0.10 to 0.42 g/L, P=0.001) in fibrinogen levels, and 0.11 U/mL (95% CI, 0.09 to 0.12 U/mL, P=0.03) in levels of vWF. The corresponding differences in FVIIa and PAI-1 were not statistically significant. With further adjustment for menopausal status, family history of CHD, marital status, psychosocial stress, lifestyle patterns, biochemical factors, and hypertension, statistically significant differences between mandatory and college/university education were observed in FVII:Ag (difference=34 microg/L; 95% CI, 2 to 65 microg/L, P=0.05) but not in fibrinogen (difference=0.03 g/L; 95% CI, -0.13 to 0.19 g/L, P=0.92) or in vWF (difference=0.06 U/mL; 95% CI, -0.10 to 0.22 U/mL, P=0.45). An educational gradient was most consistent and statistically significant for FVII:Ag, fibrinogen, and vWF. Age, psychosocial stress, unhealthful life style, atherogenic biochemical factors, and hypertension mediated the association of low educational level with elevated levels of fibrinogen and vWF. Psychosocial stress and unhealthful life style were the most important contributing factors. There was an independent association between education and FVII:Ag, which could not be explained by any of these factors.
据报道，止血因子与冠心病（CHD）相关。社会经济地位（SES）是止血指标的决定因素之一，但这种关联背后的因素尚不清楚。我们的目的是研究止血指标中社会经济差异的决定因素。1991年至1994年期间，我们对300名年龄在30至65岁之间的健康女性进行了研究，她们代表了大斯德哥尔摩地区的女性。测量了纤维蛋白原、凝血因子VII质量浓度（FVII:Ag）、活化凝血因子VII（FVIIa）、血管性血友病因子（vWF）和纤溶酶原激活物抑制剂-1（PAI-1）。教育程度被用作社会经济地位的衡量指标。低教育水平和不良的止血指标均与年龄较大、不健康的生活方式、心理社会压力、致动脉粥样硬化的生化因素以及高血压有关。止血因子水平随着教育程度的降低而升高。独立于年龄，最低（义务教育）和最高（大学/本科）教育程度之间FVII:Ag水平的差异为41μg/L（95%置信区间[CI]，15至66μg/L，P = 0.001），纤维蛋白原水平差异为0.26g/L（95%CI，0.10至0.42g/L，P = 0.001），vWF水平差异为0.11U/mL（95%CI，0.09至0.12U/mL，P = 0.03）。FVIIa和PAI-1的相应差异无统计学意义。在进一步调整绝经状态、冠心病家族史、婚姻状况、心理社会压力、生活方式模式、生化因素和高血压后，义务教育和大学/本科教育之间在FVII:Ag方面观察到统计学上的显著差异（差异 = 34μg/L；95%CI，2至65μg/L，P = 0.05），但在纤维蛋白原（差异 = 0.03g/L；95%CI，-0.13至0.19g/L，P = 0.92）或vWF（差异 = 0.06U/mL；95%CI，-0.10至0.22U/mL，P = 0.45）方面没有差异。对于FVII:Ag、纤维蛋白原和vWF，教育梯度最为一致且具有统计学意义。年龄、心理社会压力、不健康的生活方式、致动脉粥样硬化的生化因素和高血压介导了低教育水平与纤维蛋白原和vWF水平升高之间的关联。心理社会压力和不健康的生活方式是最重要的促成因素。教育与FVII:Ag之间存在独立关联，这无法用这些因素中的任何一个来解释。
