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American Journal of Epidemiology Advance Access originally published online on January 18, 2006
American Journal of Epidemiology 2006 163(7):622-628; doi:10.1093/aje/kwj076
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

Association of Educational Level with Inflammatory Markers in the Framingham Offspring Study

Eric B. Loucks1, Lisa M. Sullivan2, Laura J. Hayes2, Ralph B. D'Agostino, Sr.2,3, Martin G. Larson3,4, Ramachandran S. Vasan3,5, Emelia J. Benjamin3,6 and Lisa F. Berkman1

1 Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA
2 Department of Biostatistics, Boston University, Boston, MA
3 The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
4 Department of Mathematics, Boston University, Boston, MA
5 Department of Neurology, Boston University, Boston, MA
6 Department of Medicine and Preventive Medicine, Boston University, Boston, MA

Drs. Benjamin and Berkman contributed equally to preparation of this manuscript. Reprint requests to Dr. Eric B. Loucks, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 (e-mail: eloucks{at}hsph.harvard.edu).

Socioeconomic position consistently predicts coronary heart disease; however, the biologic mechanisms that may mediate this association are not well understood. The objective of this study was to determine whether socioeconomic position (measured as educational level) is associated with inflammatory risk factors for coronary heart disease, including C-reactive protein, interleukin-6, soluble intercellular adhesion molecule-1, monocyte chemoattractant protein-1, and P-selectin. The study sample included 2,729 participants (53.4% women; mean age, 62 ± 10 years) from the US Framingham Offspring Study cohort who attended examination cycles 3 (1984–1987) and 7 (1998–2001) and provided educational attainment data. Inflammatory markers were measured in fasting serum samples. Multivariable linear regression analyses were performed, adjusting for potential confounders including age, sex, and clinical risk factors. In age- and sex-adjusted analyses, educational attainment was significantly inversely associated with C-reactive protein (p < 0.0001), interleukin-6 (p < 0.0001), soluble intercellular adhesion molecule-1 (p < 0.0001), and monocyte chemoattractant protein-1 (p = 0.0004). After further adjustment for clinical risk factors, educational level remained significantly associated with C-reactive protein (p = 0.0002), soluble intercellular adhesion molecule-1 (p = 0.01), and monocyte chemoattractant protein-1 (p = 0.01). In conclusion, educational attainment is associated with inflammatory risk factors for coronary heart disease. The association provides evidence suggestive of a biologic pathway by which socioeconomic position may predispose to coronary heart disease.

cohort studies; inflammation; risk factors; social class

Abbreviations: IL-6, interleukin-6; MCP-1, monocyte chemoattractant protein-1; sICAM-1, soluble intercellular adhesion molecule-1


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