Persistent Pathogens Linking Socioeconomic Position and Cardiovascular Disease in the US

Citation

Simanek, Amanda M.; Dowd, Jennifer Beam; & Aiello, Allison E. (2009). Persistent Pathogens Linking Socioeconomic Position and Cardiovascular Disease in the US. International Journal of Epidemiology, 38(3), 775-787. PMCID: PMC2689394

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.

URL

http://dx.doi.org/10.1093/ije/dyn273

Reference Type

Journal Article

Year Published

2009

Journal Title

International Journal of Epidemiology

Author(s)

Simanek, Amanda M.
Dowd, Jennifer Beam
Aiello, Allison E.

PMCID

PMC2689394

ORCiD

Aiello - 0000-0001-7029-2537