Observational studyBMJ open2021
Cardiovascular risk factor mediation of the effects of education and Genetic Risk Score on cardiovascular disease: a prospective observational cohort study of the Framingham Heart Study.
Observational study in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 29 citations in OpenAlex.
- Low genetic risk for coronary artery disease underlies multigenerational longevity and healthy aging.GeroScience · 2026Article
- Cardiovascular Risk in Adolescents with Congenital Heart Disease Living in a Low-Income Region: Cross-Sectional Associations with Clinical, Behavioral and Sociodemographic Factors.Pediatric cardiology · 2026Article
- Decomposing wealth-based inequalities in ideal cardiovascular health in Kenya.Communications medicine · 2025Article
- Associations of educational attainment and traditional risk factor control with cardiovascular disease.American journal of preventive cardiology · 2025Article
- Sex-Based Associations Between Education Level, EAT-Lancet Diet, and 20-Year Cardiovascular Risk: The ATTICA Study (2002-2022).Nutrients · 2025Article
- Article
- Integrative molecular network analysis of genetic risk factors to infer biomarkers and therapeutic targets for rheumatoid arthritis.PloS one · 2025Article
- Sex-dependent effect of socioeconomic status on cardiovascular event risk in a population-based cohort of patients with type 2 diabetes.European journal of public health · 2024Article
- Serum albumin and cardiovascular disease: a Mendelian randomization study.BMC cardiovascular disorders · 2024Article
- What Is Mediation Analysis?: Linking Exposures and Outcomes Through Intermediary Mechanisms.JACC. Advances · 2024Article
- Application of marginalized zero-inflated models when mediators have excess zeroes.Statistical methods in medical research · 2024Article
- Educational inequalities in mortality and their mediators among generations across four decades: nationwide, population based, prospective cohort study based on the ChinaHEART project.BMJ (Clinical research ed.) · 2023Article
- Socioeconomic and Behavioral Determinants of Cardiovascular Risk in Russia: A Structural Equation Modeling Approach.Risk management and healthcare policy · 2023Article
- Review on the health-promoting effect of adequate selenium status.Frontiers in nutrition · 2023Review
- 30-Year High Cardiovascular Risk Incidence and its Determinants: CUME Study.Revista brasileira de enfermagem · 2023Article
- Serum copper levels and risk of major adverse cardiovascular events: a systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2023Review
- The relationship of genetic risk score with cardiometabolic risk factors: a cross-sectional study.BMC cardiovascular disorders · 2022Article
- Assessment of causal direction between thyroid function and cardiometabolic health: a Mendelian randomization study.Journal of geriatric cardiology : JGC · 2022Article
- The Association Between Dietary Antioxidant Micronutrients and Cardiovascular Disease in Adults in the United States: A Cross-Sectional Study.Frontiers in nutrition · 2021Article
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesLevel of education and genetic risk are key predictors of cardiovascular disease (CVD). While several studies have explored the causal mechanisms of education effects, it remains uncertain to what extent genetic risk is mediated by established CVD risk factors. This study sought to investigate this and explored the mediation of education and genetic effects on CVD by established cardiovascular risk factors in the Framingham Heart Study (FHS).
designProspective observational cohort study.
participants7017 participants from the FHS.
settingCommunity-based cohort of adults in Framingham, Massachusetts, USA. PRIMARY OUTCOME MEASURE: Incident CVD. The total effects of education and genetic predisposition using a 63-variant genetic risk score (GRS) on CVD, as well as those mediated by established CVD risk factors, were assessed via mediation analysis based on the counterfactual framework using Cox proportional hazards regression models.
resultsOver a median follow-up time of 12.0 years, 1091 participants experienced a CVD event. Education and GRS displayed significant associations with CVD after adjustment for age and sex and the established risk factors smoking, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), body mass index, systolic blood pressure (SBP) and diabetes. For education effects, smoking, HDL-C and SBP were estimated to mediate 18.8% (95% CI 9.5% to 43%), 11.5% (95% CI 5.7% to 29.0%) and 4.5% (95% CI 1.6% to 13.3%) of the total effect of graduate degree, respectively, with the collective of all risk factors combined mediating 38.5% (95% 24.1% to 64.9%). A much smaller proportion of the effects of GRS were mediated by established risk factors combined (17.6%, 95% CI 2.4% to 35.7%), with HDL-C and TC mediating 11.5% (95% CI 6.2% to 21.5%) and 3.1% (95% CI 0.2% to 8.3%), respectively.
conclusionsUnlike education inequalities, established risk factors mediated only a fraction of GRS effects on CVD. Further research is required to elucidate the underlying causal mechanisms of genetic contributions to CVD.
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