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. 2009 Jun;38(3):775-87.
doi: 10.1093/ije/dyn273. Epub 2008 Dec 24.

Persistent pathogens linking socioeconomic position and cardiovascular disease in the US

Amanda M Simanek  1 , Jennifer Beam Dowd, Allison E Aiello
Affiliations

Persistent pathogens linking socioeconomic position and cardiovascular disease in the US

Amanda M Simanek et al. Int J Epidemiol. 2009 Jun.

Abstract

Background: Numerous studies have documented a strong inverse association between cardiovascular disease and socioeconomic position (SEP). Several infections are associated with both cardiovascular disease and SEP; hence infection may form an important link between SEP and cardiovascular disease. This study examines whether seropositivity to cytomegalovirus (CMV), to herpes simplex virus type-1 (HSV-1), and/or to both pathogens mediates the relationship between SEP and cardiovascular disease history in a nationally representative sample of the United States.

Methods: We conducted a cross-sectional study of subjects > or =45 years of age, who were tested for seropositivity to CMV, HSV-1 or both pathogens and assessed for cardiovascular disease history in the National Health and Nutrition Examination Survey III. Cardiovascular disease history was defined as history of stroke, heart attack and/or congestive heart failure and SEP as education level.

Results: SEP was associated with CMV, HSV-1 and seropositivity to both pathogens. CMV seropositivity was associated with cardiovascular disease history even after adjusting for confounders as well as SEP. The odds of reporting a history of cardiovascular disease for those with less than a high school education compared with those with more than a high school education decreased by 7.7% after adjusting for CMV (Sobel mediation test for CMV, P = 0.0006). In contrast, neither seropositivity to HSV-1 nor to both pathogens was associated with cardiovascular disease history after adjusting for SEP.

Conclusions: Persistent pathogens such as CMV infection may explain a portion of the relationship between SEP and cardiovascular disease in the United States. Further studies examining additional pathogens and sociobiological mechanisms are warranted.

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Figures

Figure 1
Figure 1
Derivation of study sample
Figure 2
Figure 2
Potential confounders in the relationships between SEP, pathogens and cardiovascular disease
See this image and copyright information in PMC

Comment in

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