Roles of allostatic load, lifestyle and clinical risk factors in mediating the association between education and coronary heart disease risk in Europe

Abstract

BackgroundPrevious studies have shown that differential exposure to lifestyle factors may mediate the association between education and coronary heart diseases (CHD). However, few studies have examined the potential roles of allostatic load (AL) or differential susceptibility.Methods25 310 men and 26 018 women aged 35–74 and CHD free at baseline were identified from 21 European cohorts and followed for a median of 10 years, to investigate the mediating role of AL, as well as of smoking, alcohol use and body mass index (BMI), on educational differences in CHD incidence, applying marginal structural models and three-way decomposition.ResultsAL is a mediator of the association between educational status and CHD incidence, with the highest proportion mediated observed among women and largely attributable to differential exposure, (28% (95% CI 19% to 44%)), with 8% (95% CI 0% to 16%) attributable to differential susceptibility. The mediating effects of smoking, alcohol and BMI, compared with AL, were relatively small for both men and women.ConclusionOverall, the educational inequalities in CHD incidence were partially mediated through differential exposure to AL. By contrast, the mediation of the educational gradient in CHD by investigated lifestyle risk factors was limited. As differential susceptibility in men was found to have a predominant role in the accumulation of AL in low educational classes, the investigation of AL-related risk factors is warranted.

Biomarkers of Allostatic Load in Patients with Diabetic Retinopathy

“…Среди пациентов с сахарным диабетом 2-го типа, не имеющих ДР, выявлено иное распределение составляющих аллостатическую нагрузку, формирование которой обусловлено преимущественно САД, уровнем альбумина и триглицеридов в периферической крови. Это указывает на то, что аллостатическая нагрузка в зависимости от вида заболевания затрагивает различные системы, включая сердечно-сосудистую, метаболическую и нейроэндокринную, а также отражает наличие воспалительного процесса [6,7,11].…”

“…Zheng и соавт. [4], является аллостатическая нагрузка, отражающая совокупно физиологический износ или истощение физиологического (функционального) резерва в ответ на стресс в течение жизни [5][6][7]. Это связано с тем, что люди с нарушением зрения могут испытывать повышенный жизненный стресс, что, в свою очередь, приводит к повышению аллостатической нагрузки [4].…”

Planning for health equity in the crossfire between science and policy

“…New causal inference methods have been developed and an increasing number of studies have estimated the simultaneous effect of both mediation and interaction. So far, such studies have found that the mechanism of differential vulnerability to the effects of, for example, alcohol, smoking and obesity, as well as stress-induced allostatic load [19], plays a part, but that differential exposure is the dominant mechanism. It is thus a challenge for policy-makers to navigate in the crossfire between some researchers arguing for a major re-think and politicians increasingly impatient with a lack of progress on their policy-focused questions.…”

Association between allostatic load and adverse outcomes among older patients with heart failure with preserved ejection fraction

“…Studies have shown that [ 16 ] a high AL burden is associated with all-cause and cardiovascular mortality among adults in the United States. Additionally, AL has been shown to mediate the occurrence of coronary heart disease in association with educational level or depression [ 17 , 18 ]. However, no studies have focused on the association between AL and the prognosis of patients with HFpEF.…”