Education, lifestyle factors and mortality from cardiovascular diseased and cancer. A 25-year follow-up of Swedish 50-year-old men

Background There is a well-established inverse relation between education a nd mortality from cardiovascular disease and cancer. The reasons for this a re still in part unclear. We aimed to investigate whether differences in tr aditional vascular risk factors, adult height, physical activity, and bioma rkers of fatty acid and antioxidant intake, could explain this association. Methods In all, 2301 50-year-old men in Uppsala, Sweden (82% of the backgro und population) were examined with regard to educational level, blood press ure, blood glucose, body mass index, serum lipids, smoking, body height, ph ysical 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 c ardiovascular 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 e ducational attainment. Men with high education had an overall more benefici al 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 betw een education and cardiovascular mortality disappeared (RR in low education = 1.01. 95% CI : 0.67-1.52). Controlling for smoking, physical activity an d dietary biomarkers explained less than half of the excess cancer mortalit y 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 est ers (adjusted RR per I SD = 1.39, 95% CI : 1.07-1.82) predicted cancer mort ality independently of all other factors. There were no independent relatio ns between serum antioxidants and mortality. Conclusions These data indicate that modifiable lifestyle factors mediate t he inverse gradient between education and death from cerebro- and cardiovas cular disease. Smoking, physical activity and dietary factors explained hal f 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.