Groffen Daniëlle A I, Bosma Hans, Koster Annemarie, von Bonsdorff Mikaela B, Aspelund Thor, Eiriksdottir Gudny, Penninx Brenda W J H, Kempen Gertrudis I J M, Kirschbaum Clemens, Gudnason Vilmundur, Harris Tamara B
CAPHRI School for Public Health and Primary Care, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
CAPHRI School for Public Health and Primary Care, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
Soc Sci Med. 2015 Feb;127:143-9. doi: 10.1016/j.socscimed.2014.09.050. Epub 2014 Sep 28.
Lower educational attainment generally is a strong predictor of coronary heart disease (CHD). The underlying mechanisms of this effect are, however, less clear. One hypothesis is that stress related to limitations imposed by lower socioeconomic status elicits changes in hypothalamic-pituitary-adrenal axis functioning, which, in turn, increases risk of CHD. In a large cohort study, we examined whether educational attainment was related to risk of fatal and non-fatal CHD and the extent to which salivary cortisol mediated this relation independent of potential confounders, including lifestyles. Data came from 3723 participants aged 66 through 96 from the Age, Gene/Environment Susceptibility (AGES) - Reykjavik Study. Between 2002 and 2006, data were collected using questionnaires and examinations including morning and evening salivary samples. Hospital admission records and cause of death registries (ICD-9 and ICD-10 codes) were available until December 2009. Linear regression and Cox proportional hazards analyses were performed. Even after adjustment for potential confounders, including lifestyle, persons with lower educational attainment showed a blunted cortisol response and also greater risk of incident CHD. However, our data did not support the role of cortisol as a mediator in the association between education and CHD in an older sample (192).
受教育程度较低通常是冠心病（CHD）的一个有力预测指标。然而，这种影响的潜在机制尚不清楚。一种假说认为，较低社会经济地位所带来的限制相关的压力会引发下丘脑 - 垂体 - 肾上腺轴功能的变化，进而增加冠心病风险。在一项大型队列研究中，我们检验了受教育程度是否与致命性和非致命性冠心病风险相关，以及唾液皮质醇在多大程度上独立于包括生活方式在内的潜在混杂因素介导了这种关系。数据来自于年龄、基因/环境易感性（AGES）-雷克雅未克研究中3723名年龄在66岁至96岁之间的参与者。在2002年至2006年期间，通过问卷调查和检查收集数据，包括早晨和晚上的唾液样本。可获取截至2009年12月的住院记录和死亡原因登记（国际疾病分类第9版和第10版编码）。进行了线性回归和Cox比例风险分析。即使在对包括生活方式在内的潜在混杂因素进行调整后，受教育程度较低的人仍表现出皮质醇反应迟钝，且冠心病发病风险更高。然而，我们的数据并不支持在老年样本（192）中皮质醇作为教育与冠心病之间关联的中介作用。
