Education, lifestyle factors and mortality from cardiovascular diseased and cancer. A 25-year follow-up of Swedish 50-year-old men
Education, lifestyle factors and mortality from cardiovascular diseased and cancer. A 25-year follow-up of Swedish 50-year-old men
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DOI：
10.1093/ije/30.5.1119
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发表时间：
2001-10-01
影响因子：
7.7
通讯作者：
Lithell, H
中科院分区：
文献类型：
--
作者：
Kilander, L;Berglund, L;Lithell, H
教育程度与心血管疾病和癌症死亡率之间存在明显的负相关关系。造成这种情况的部分原因尚不清楚。我们的目的是研究传统血管危险因素、成人身高、身体活动、脂肪酸和抗氧化剂摄入的生物标志物的差异是否可以解释这种关联。方法对瑞典乌普萨拉市2301名50岁男性（占背景人群的82%）进行教育程度、血压、血糖、体重指数、血脂、吸烟、身高、体力活动、血清β -胡萝卜素、α -生育酚、硒和胆固醇酯中的血清脂肪酸等方面的检查。死因特异性死亡率在25年后登记。结果与受教育程度高的人相比，受教育程度低的人心血管疾病（粗相对危险度[RR] = 1.67, 95% CI: 1.17-2.39）和癌症（粗相对危险度[RR] = 1.94, 95% CI: 1.21-3.10）的死亡率更高。总体而言，受过高等教育的男性在传统心血管风险因素、身体活动和饮食中抗氧化剂和脂肪摄入的生物标志物方面具有更有利的风险因素。在对所有检查的危险因素进行调整后，受教育程度与心血管死亡率之间的负相关梯度消失（低受教育程度的RR = 1.01）。95% ci: 0.67-1.52)。在控制吸烟、体育活动和饮食生物标志物的情况下，低教育程度人群中癌症死亡率高的原因不到一半。吸烟（校正后的RR = 1.89, 95% CI: 1.37-2.61）和血清胆固醇酯中棕榈油酸的高比例（校正后的RR / SD = 1.39, 95% CI: 1.07-1.82）独立于所有其他因素预测癌症死亡率。血清抗氧化剂与死亡率之间无独立关系。结论这些数据表明，可改变的生活方式因素介导了教育程度与大脑和心血管疾病死亡之间的反向梯度。在受教育程度较低的人群中，吸烟、体育活动和饮食因素可以解释一半的癌症死亡率。棕榈油酸是动物脂肪和乳制品脂肪摄入量高的标志，需要进一步的研究来探索棕榈油酸与癌症之间的联系。
Background There is a well-established inverse relation between education and mortality from cardiovascular disease and cancer. The reasons for this are still in part unclear. We aimed to investigate whether differences in traditional vascular risk factors, adult height, physical activity, and biomarkers of fatty acid and antioxidant intake, could explain this association.Methods In all, 2301 50-year-old men in Uppsala, Sweden (82% of the background population) were examined with regard to educational level, blood pressure, blood glucose, body mass index, serum lipids, smoking, body height, physical activity, serum beta carotene, alpha tocopherol, selenium, and serum fatty acids in cholesterol esters. Cause-specific mortality was registered 25 years later.Results Low education was associated with a higher rate of mortality from cardiovascular disease (crude relative risk [RR] = 1.67, 95% CI : 1.17-2.39), and from cancer (crude RR = 1.94, 95% CI : 1.21-3.10), compared to high educational attainment. Men with high education had an overall more beneficial risk factor profile concerning traditional cardiovascular risk factors, physical activity, and biomarkers of dietary intake of antioxidants and fat. After adjustment for all examined risk factors, the inverse gradient between education and cardiovascular mortality disappeared (RR in low education = 1.01. 95% CI : 0.67-1.52). Controlling for smoking, physical activity and dietary biomarkers explained less than half of the excess cancer mortality in the lower educational groups. Smoking (adjusted RR = 1.89, 95% CI : 1.37-2.61), and high proportions of palmitoleic acid in serum cholesterol esters (adjusted RR per I SD = 1.39, 95% CI : 1.07-1.82) predicted cancer mortality independently of all other factors. There were no independent relations between serum antioxidants and mortality.Conclusions These data indicate that modifiable lifestyle factors mediate the inverse gradient between education and death from cerebro- and cardiovascular disease. Smoking, physical activity and dietary factors explained half of the excess cancer mortality in lower educated groups. Further studies are needed to explore the proposed association between palmitoleic acid, a marker of high intake of animal and dairy fat, and cancer.