Social determinants of von Willebrand factor - The Whitehall II Study

Data from the Whitehall II Study and others have demonstrated a role for th e metabolic syndrome and fibrinogen underlying the association between soci al position and coronary heart disease. In this study, we examined the role of an additional hemostatic factor and marker of endothelial dysfunction, von Willebrand factor (vWF), Four thousand five hundred and forty-eight men and 1837 women were examined in the third phase of the study, which took p lace between 1991 and 1993, Employment grade was used as a measure of socio economic position. An inverse relation between employment grade and vWF was evident (P < 0.0003). This employment grade gradient was apparent overall, and the relation persisted even when nonsmokers and participants with poor health were removed from the analyses (P = 0.02). The difference between t he highest (unified grades 1 to 6) and lowest (clerical/support) employment grades in vWF concentrations was 8.9 IU/dL (95% CI 6.0, 11.8; P < 0.001) f or men and 6.9 IU/dL (95% CI 4.0, 9.7; P = 0.06) for women. vWF was associa ted with a number of biological factors that themselves showed an employmen t grade gradient, including fibrinogen (P < 0.001), fasting and postload gl ucose (P < 0.05) levels, and fasting and postload insulin (P < 0.01) levels . Associations with smoking and alcohol intake were apparent. Smoking showe d a threshold effect, such that only men who smoked >21 cigarettes per day produced a significantly increased vWF level (P < 0.05) compared with light er smokers. The health-related behaviors explained 25% of the grade gradien t in men and 28% in women, while the biological factors accounted for 32% i n men and 22% in women. We conclude that there is a grade gradient in vWF t hat was not fully explained by health-related behaviors and risk factors fo r coronary heart disease. These data are consistent with the hypothesis tha t endothelial dysfunction is part of the explanation for social inequalitie s in cardiovascular disease.