Education, lifestyle factors and mortality from cardiovascular disease and cancer. A 25-year follow-up of Swedish 50-year-old men

Kilander, Lena; Berglund, Lars; Boberg, Merike; Vessby, Bengt; Lithell, Hans

doi:10.1093/ije/30.5.1119

Cited by 151 publications

(114 citation statements)

References 38 publications

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“…An alternative is to develop public health policy prevention programmes. Aspects of socioeconomic status such as occupation, 3 educational attainment, 4 and income; 5 lifestyle factors such as smoking, 6 adverse dietary habits, 7 and physical inactivity; 8 and overweight 9 are associated with CHD. Evaluation of the contribution of each of these factors to the high risk of CHD in the population would help focus the policies and interventions for prevention.…”

Section: Introductionmentioning

confidence: 99%

Coronary heart disease risk in men and the epidemic of overweight and obesity

et al. 2004

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OBJECTIVE:To evaluate the contributions of socioeconomic, lifestyle, and body weight factors to predicted risk of coronary heart disease (CHD) in the population and thus provide a focus for policies on prevention. DESIGN: Prospective study and cross-sectional population health survey. SUBJECTS: In all, 3090 men in the Framingham study and 2571 men in the 1998 Health Survey for England (HSE) aged 35-74 y with no history of cardiovascular disease participated in the study. MEASUREMENTS: Data on sex, age, systolic blood pressure and antihypertensive medication, total and high-density lipoprotein cholesterol levels, diabetes, and their association with the incidence of myocardial infarction and fatal CHD in the Framingham study population were used to derive functions for predicting individual 10-y risk of CHD. These functions were applied to the same data on participants in the HSE. High risk was defined as 10-y CHD risk Z15%. The proportion of high risk in the English population attributable to each of the risk factors examined was assessed. RESULTS: In all, 32% of men in England had predicted 10-y CHD risk Z15%. Such high risk was significantly associated with body mass index (BMI, kg/m 2 ), waist:hip ratio (WHR), smoking, and levels of physical activity, educational attainment, and income (all Pr0.007). In this population, 47% of high CHD risk was attributable to excess body weightFBMI Z25 kg/m 2 and/ or WHR Z0.95Fand 31% to the sum of the four other significant factors: lack of educational qualifications, low income, smoking, and physical inactivity. CONCLUSION: Overweight and obesity now dominate the standard risk factors of CHD in men and should be the focus of national policies for prevention.

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Section: Introductionmentioning

confidence: 99%

Coronary heart disease risk in men and the epidemic of overweight and obesity

et al. 2004

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“…First, controlled secondary prevention trials have reported protective effects of increased ALA intake 41,42 or a trend toward decreased CVD risk in women. 40 A recent meta-analysis also reported a nonsignificant trend toward lower CVD risk at higher levels of ALA biomarkers. 43 Second, ALA in serum CE seems to be a weaker biomarker of dietary intake compared with LA, EPA, and DHA, as reported in Swedish men who were investigated during the same time period as in the present study.…”

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confidence: 97%

Polyunsaturated Fat Intake Estimated by Circulating Biomarkers and Risk of Cardiovascular Disease and All-Cause Mortality in a Population-Based Cohort of 60-Year-Old Men and Women

et al. 2015

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Background-High intake of polyunsaturated fatty acids (PUFAs) may reduce the risk of cardiovascular disease (CVD) and mortality. Large, prospective studies including both sexes and circulating PUFAs as dietary biomarkers are needed. We investigated sex-specific associations of the major dietary PUFAs, eicosapentaenoic acid, docohexaenoic acid, linoleic acid, and α-linolenic acid, with incident CVD and all-cause mortality in a population-based cohort. Methods and Results-PUFAs in serum cholesterol esters were measured at baseline in 60-year-old Swedish women (n=2193) and men (n=2039). With the use of national registers, 484 incident CVD events (294 men and 190 women) and 456 all-cause deaths (265 men and 191 women) were identified during follow-up (median, 14.5 years) in individuals without prior CVD at baseline. Associations of PUFAs with CVD and mortality were evaluated with Cox proportional hazard models. In multivariable-adjusted models, 1-SD increases in eicosapentaenoic acid and docohexaenoic acid were associated with lower risk of incident CVD among women (hazard ratio PUFAs seem to have selective roles in the development of CVD, whereas possible influences on non-CVD outcomes are less clear. 9 Dietary intake of EPA, DHA, LA, and, to a lesser extent, ALA is reflected in the FA composition in serum cholesteryl esters (CEs); thus, the proportions of these PUFAs in CEs can be used as biomarkers to assess the intake of the respective PUFA.[10-12 Accordingly, FA composition (especially EPA, DHA, and LA) in CEs correlates well with self-reported FA intake in both Swedish 13 and other cohorts.14 Several prospective cohort and nested case-control studies have used serum CE FAs as a biomarker of dietary fat and investigated possible relationships with risks of all-cause and CVD mortality, 15 fatal coronary heart disease (CHD), 16 and incidences of CHD, 17 heart failure, 18 and stroke. 19,20 Among middle-aged Swedish men, a 1-SD increase (5.2%) in serum CE LA was associated with 13% and 15% lower risk of all-cause and CVD mortality, respectively, whereas no significant associations were observed for serum CE EPA, DHA, or ALA. In addition, a recent meta-analysis suggested that CE LA is associated with a lower risk of fatal CHD, whereas no such associations have been observed for n-3 PUFAs. 16 However, previous studies investigating relationships between serum CE PUFAs and CVD-related outcomes have included predominantly men, although men and women may differ in CVD risks and mortality. 21 Thus, identification of possible sex-specific associations might have been hampered by the limited number of women.Furthermore, recent studies have reported inverse associations of both n-6 and n-3 PUFAs in plasma phospholipid with all-cause and cause-specific mortality and with incident CVD in a US cohort of older men and women. 22,23 This study investigated associations between biomarkers of PUFA intake (EPA, DHA, LA, and ALA) in serum CEs and incident CVD and all-cause mortality in men and women, separately and combined, in a ...

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“…11 13 [17][18][19][20] Evidence is also accruing that educated men and women in the developing world have lower mortality, but the mechanisms underlying this association are not fully understood. [7][8][9] Understanding social inequalities in developing countries may require looking into the independent effects of individuals within households over and above those between households, partly because women's and men's roles within a household are so distinct.…”

mentioning

confidence: 99%

Effects of education and other socioeconomic factors on middle age mortality in rural Bangladesh

Hurt

2004

Journal of Epidemiology & Community Health

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Study objective: To examine socioeconomic gradients in mortality in adult women and their husbands in Bangladesh, paying particular attention to the independent effects of the educational status of each spouse. Design: Historical cohort study. Setting: Matlab, a rural area 60 km south east of Dhaka, the capital of Bangladesh. Participants: 14 803 married women aged 45 or over and their husbands who were resident in the Matlab Demographic Surveillance area between 30 June 1982 and 31 December 1998. Main results: Mortality was lower in women with formal or Koranic education compared with those with none (adjusted rate ratio for formal education = 0.68, 95% CI 0.53 to 0.86; adjusted rate ratio for Koranic schooling = 0.82, 95% CI 0.66 to 1.00). After adjusting for her own education, the husband's level of education or occupation did not have an independent effect on a woman's survival. Men who had attended formal education had lower mortality than those without any education (adjusted rate ratio = 0.84, 95% CI 0.75 to 0.93), but men whose wives had been educated had an additional survival advantage independent of their own education and occupation (adjusted rate ratio = 0.76, 95% CI 0.67 to 0.87). Mortality in both sexes was also significantly associated with marital status and the percentage of surviving children, and in men was associated with the man's occupation, religion, area of residence. Conclusions: The data suggest that socioeconomic status has a strong influence on mortality in adults in Bangladesh. They also illustrate how important the continued promotion of education, particularly for women, may be for the survival of both women and men in rural Bangladesh. I t has long been recognised that people who are socially disadvantaged have higher mortality. Social or economic gradients in adult mortality have consistently been observed in affluent societies 1 2 and studies in the developing world have also found substantial inequalities.3-9 Increasing attention is now being paid to understanding the nature of such inequalities and the pathways through which they exert their effects. 10One of the critical factors in this pathway is adult education. In affluent societies, a consistent association between the educational status of adults and their mortality has been shown, independent of other social or economic factors.11-14 Effects are seen in both women and men, although they might be slightly weaker in women than in men.15 16 Factors thought to contribute to the lower mortality of educated people are improvements in their employment opportunities and material circumstances, and an increased knowledge about health matters with consequent reductions in risky health behaviours.11 13 [17][18][19][20] Evidence is also accruing that educated men and women in the developing world have lower mortality, but the mechanisms underlying this association are not fully understood. [7][8][9] Understanding social inequalities in developing countries may require looking into the independent effects of individuals within hous...

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Education, lifestyle factors and mortality from cardiovascular disease and cancer. A 25-year follow-up of Swedish 50-year-old men

Cited by 151 publications

References 38 publications

Coronary heart disease risk in men and the epidemic of overweight and obesity

Coronary heart disease risk in men and the epidemic of overweight and obesity

Polyunsaturated Fat Intake Estimated by Circulating Biomarkers and Risk of Cardiovascular Disease and All-Cause Mortality in a Population-Based Cohort of 60-Year-Old Men and Women

Effects of education and other socioeconomic factors on middle age mortality in rural Bangladesh

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