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Educational Attainment and Coronary and Aortic Calcification in Postmenopausal Women

From the Department of Psychiatry (L.C.G., K.A.M.) and Department of Medicine (D.E.), University of Pittsburgh School of Medicine, and the Graduate School of Public Health (L.H.K., K.S.T), University of Pittsburgh, Pittsburgh, PA.

Address reprint requests to: Karen A. Matthews, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA 15213. Email: matthewska{at}msx.upmc.edu Address correspondence to: Linda C. Gallo, PhD, SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120-4913. Email: lgallo@sciences.sdsu.edu

OBJECTIVE: Low socioeconomic status is a risk factor for clinical coronary heart disease, a relatively crude outcome associated with important biases. By avoiding these biases, subclinical assessments could facilitate efforts to understand the association between socioeconomic status and coronary disease. The current study 1) evaluated the nature of the associations between educational attainment and subclinical atherosclerosis and 2) examined if biologic, behavioral, and psychosocial factors mediated these associations.

METHODS: Participants were 308 women from the Healthy Women Study who underwent a clinic examination of risk factors either 5 (N = 32) or 8 (N = 276) years after the menopausal transition. Aortic and coronary calcification were measured using electron beam tomography.

RESULTS: Logistic regression analysis with orthogonal polynomials revealed a marginally significant linear trend for coronary calcification, with the more educated groups showing lower calcification than the less educated groups. A significant linear trend was also observed for aortic calcification. In addition, a marginally significant quadratic trend was observed for aortic calcification so that the effect began to reverse at the highest level of education. Measured risk factors were associated with education and with the calcification outcomes, but they explained little of the associations between educational attainment and coronary or aortic calcification. None of the factors tested met the minimum criterion for mediation.

CONCLUSIONS: The findings show that lower education is associated with greater early stage atherosclerosis. Subclinical assessments, such as electron beam tomography, represent useful alternatives for studies of socioeconomic status and coronary artery disease.

Key Words: atherosclerosis, • calcium, • educational level, • risk factors, • psychosocial, • socioeconomic factors.

Abbreviations: ANOVA = analysis of variance;; DBP = diastolic blood pressure;; EBT = electron beam tomography;; HDL-C = high-density lipoprotein cholesterol;; HRT = hormone replacement therapy;; HWS = Healthy Women Study;; LDL-C = low-density lipoprotein cholesterol;; SBP = systolic blood pressure;; SES = socioeconomic status.

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