Educational attainment and coronary and aortic calcification in postmenopausal women

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 di sease. The current study 1) evaluated the nature of the associations betwee n 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 und erwent 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 line ar trend for coronary calcification, with the more educated groups showing lower calcification than the less educated groups. A significant linear tre nd was also observed for aortic calcification. In addition, a marginally si gnificant quadratic trend was observed for aortic calcification so that the effect began to reverse at the highest level of education. Measured risk f actors were associated with education and with the calcification outcomes, but they explained little of the associations between educational attainmen t 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. Subclinic al assessments, such as electron beam tomography, represent useful alternat ives for studies of socioeconomic status and coronary artery disease.