Socioeconomic status and determinants of hemostatic function in healthy women

Hemostatic factors are reported to be associated with coronary heart diseas e (CHD). Socioeconomic status (SES) is 1 of the determinants of the hemosta tic profile, but the factors underlying this association are not well known . Our aim was to examine determinants of the socioeconomic differences in h emostatic profile. Between 1991 and 1994, we studied 300 healthy women, age d 30 to 65 years, who were representative of women living in the greater St ockholm area. Fibrinogen, factor VII mass concentration (FVII:Ag), activate d factor VII (FVIIa), von Willebrand factor (vWF), and plasminogen activato r inhibitor-1 (PAI-1) were measured. Educational attainment was used as a m easure of SES. Low educational level and an unfavorable hemostatic profile were both associated with older age, unhealthful life style, psychosocial s tress, atherogenic biochemical factors, and hypertension. Levels of hemosta tic factors increased with lower educational attainment. Independently of a ge, the differences between the lowest (mandatory) and highest (college/uni versity) education in FVII:Ag levels were 41 mu g/L (95% confidence interva l [CI] 15 to 66 mu g/L, P=0.001), 0.26 g/L (95% CI, 0.10 to 0.42 g/L, P=0.0 01) in fibrinogen levels, and 0.11 U/mL (95% CI, 0.09 to 0.12 U/mL, P=0.03) in levels of vWF. The corresponding differences in FVIIa and PAI-1 were no t statistically significant. With further adjustment for menopausal status, family history of CHD, marital status, psychosocial stress, lifestyle patt erns, biochemical factors, and hypertension, statistically significant diff erences between mandatory and college/university education were observed in FVII:Ag (difference=34 mu g/L; 95% CI, 2 to 65 mu g/L, P=0.05) but not in fibrinogen (difference 0.03 g/L; 95% CI, -0.13 to 0.19 g/L, P=0.92) or in V WF (difference=0.06 U/mL; 95% CI, -0.10 to 0.22 U/mL, P=0.45). An education al gradient was most consistent and statistically significant for FVII:Ag, fibrinogen, and VWF. Age, psychosocial stress, unhealthful life style, athe rogenic biochemical factors, and hypertension mediated the association of l ow educational level with elevated levels of fibrinogen and vWF. Psychosoci al stress and unhealthful life style were the most important contributing f actors. There was an independent association between education and FVII:Ag, which could not be explained by any of these factors.