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Published in: BMC Cardiovascular Disorders 1/2019

Open Access 01-12-2019 | Research article

Homocysteine and education but not lipoprotein (a) predict estimated 10-year risk of cardiovascular disease in blood donors: a community based cross-sectional study

Authors: Francesco Vadini, Francesca Santilli, Giuseppe Casalini, Mario dell’Isola, Ornella Iuliani, Damiano D’Ardes, Luisa Lattanzio, Marta Di Nicola, Giancarlo Di Iorio, Patrizia Accorsi

Published in: BMC Cardiovascular Disorders | Issue 1/2019

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Abstract

Background

With aging of the population, screening and prevention health programs for blood donors will increasingly be a priority. We aimed at: assessing the 10 year-cardiovascular disease (CVD) risk in blood donors, according to Italian CUORE risk score (CRS); determining the association of homocysteine (Hcy), lipoprotein (Lp)(a) and socio-demographic or lifestyle variables with estimated 10-year CVD risk.

Methods

Between June 2015 and July 2017, 1,447 (61.2% men) unselected blood donors (aged 18–69 years) were enrolled at the Blood Transfusion Service of the Pescara General Hospital, Italy. The project entailed evaluation of unalterable (age and gender) and modifiable CV risk factors (total cholesterol, HDL, LDL, triglycerides, fasting glucose, smoking, hypertension). The educational attainment, socio-demographic and lifestyle behavior information were obtained through a structured self-report questionnaire, and Health-related quality of life (HRQoL) through the Short Form Survey (SF-12). Plasma Hcy and Lp(a) were determined in the fasting state.

Results

A CRS within the moderate-high risk range was reported in 21.7% donors. Multivariate logistic regression, after adjustment for clinical and demographic variables, showed that Hcy [OR (95% CI): 1.09 (1.04–1.13); p < 0.001) and low educational attainment [1.71 (1.09–2.73); p = 0.019] are independent risk factors for moderate-to-high CVD risk. Instead, Lp(a), evaluated in 774 donors, was > 30 mg/dL in 22.4% of the examined population, but without any significant correlation with CRS.

Conclusions

Our study highlights a previously unappreciated need for CV risk assessment in blood donors, which may include evaluation of educational attainment as a non-traditional risk marker.
Literature
1.
go back to reference Ali A, Auvinen MK, Rautonen J. The aging population poses a global challenge for blood services. Transfusion. 2010;50(3):584–8.CrossRef Ali A, Auvinen MK, Rautonen J. The aging population poses a global challenge for blood services. Transfusion. 2010;50(3):584–8.CrossRef
2.
go back to reference Barquera S, Pedroza-Tobías A, Medina C, Hernández-Barrera L, Bibbins-Domingo K, Lozano R, et al. Global overview of the epidemiology of atherosclerotic cardiovascular disease. Arch Med Res. 2015;46(5):328–38.CrossRef Barquera S, Pedroza-Tobías A, Medina C, Hernández-Barrera L, Bibbins-Domingo K, Lozano R, et al. Global overview of the epidemiology of atherosclerotic cardiovascular disease. Arch Med Res. 2015;46(5):328–38.CrossRef
3.
go back to reference Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–59.CrossRef Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–59.CrossRef
4.
go back to reference Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WM, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012): the fifth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Atherosclerosis. 2012;223(1):1–68.CrossRef Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WM, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012): the fifth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Atherosclerosis. 2012;223(1):1–68.CrossRef
5.
go back to reference Anderson TJ, Gregoire J, Hegele RA, Couture P, Mancini GB, McPherson R, et al. 2012 update of the Canadian cardiovascular society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013;29(2):151–67.CrossRef Anderson TJ, Gregoire J, Hegele RA, Couture P, Mancini GB, McPherson R, et al. 2012 update of the Canadian cardiovascular society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013;29(2):151–67.CrossRef
6.
go back to reference Veeranna V, Zalawadiya SK, Niraj A, Pradhan J, Ference B, Burack RC, et al. Homocysteine and reclassification of cardiovascular disease risk. J Am Coll Cardiol. 2011;58(10):1025–33.CrossRef Veeranna V, Zalawadiya SK, Niraj A, Pradhan J, Ference B, Burack RC, et al. Homocysteine and reclassification of cardiovascular disease risk. J Am Coll Cardiol. 2011;58(10):1025–33.CrossRef
7.
go back to reference Nordestgaard BG, Chapman MJ, Ray K, Borén J, Andreotti F, Watts GF, et al. European atherosclerosis society consensus panel. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010;31(23):2844–53.CrossRef Nordestgaard BG, Chapman MJ, Ray K, Borén J, Andreotti F, Watts GF, et al. European atherosclerosis society consensus panel. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010;31(23):2844–53.CrossRef
8.
go back to reference Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81.CrossRef Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81.CrossRef
9.
go back to reference Almeida RP, Schultz SA, Austin BP, Boots EA, Dowling NM, Gleason CE, et al. Effect of cognitive reserve on age-related changes in cerebrospinal fluid biomarkers of Alzheimer disease. JAMA Neurol. 2015;72(6):699–706.CrossRef Almeida RP, Schultz SA, Austin BP, Boots EA, Dowling NM, Gleason CE, et al. Effect of cognitive reserve on age-related changes in cerebrospinal fluid biomarkers of Alzheimer disease. JAMA Neurol. 2015;72(6):699–706.CrossRef
10.
go back to reference Maritza Dowling N, Gleason CE, Groot C, Galimberti D, Graff C, Masellis M, et al. Cognitive reserve and TMEM106B genotype modulate brain damage in presymptomatic frontotemporal dementia: a GENFI study. Brain. 2017;140(6):1784–91.CrossRef Maritza Dowling N, Gleason CE, Groot C, Galimberti D, Graff C, Masellis M, et al. Cognitive reserve and TMEM106B genotype modulate brain damage in presymptomatic frontotemporal dementia: a GENFI study. Brain. 2017;140(6):1784–91.CrossRef
11.
go back to reference Groot C, van Loenhoud AC, Barkhof F, van Berckel BNM, Koene T, Teunissen CC, et al. Differential effects of cognitive reserve and brain reserve on cognition in Alzheimer disease. Neurology. 2018;90(2):e149–56.CrossRef Groot C, van Loenhoud AC, Barkhof F, van Berckel BNM, Koene T, Teunissen CC, et al. Differential effects of cognitive reserve and brain reserve on cognition in Alzheimer disease. Neurology. 2018;90(2):e149–56.CrossRef
12.
go back to reference Dégano IR, Marrugat J, Grau M, Salvador-González B, Ramos R, Zamora A, et al. The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index. Sci Rep. 2017;7(1):12370.CrossRef Dégano IR, Marrugat J, Grau M, Salvador-González B, Ramos R, Zamora A, et al. The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index. Sci Rep. 2017;7(1):12370.CrossRef
13.
go back to reference Ferrario M, Chiodini P, Chambless LE, Cesana G, Vanuzzo D, Panico S, et al. CUORE project research group. Prediction of coronary events in a low incidence population. Assessing accuracy of the CUORE cohort study prediction equation. Int J Epidemiol. 2005;34(2):413–21.CrossRef Ferrario M, Chiodini P, Chambless LE, Cesana G, Vanuzzo D, Panico S, et al. CUORE project research group. Prediction of coronary events in a low incidence population. Assessing accuracy of the CUORE cohort study prediction equation. Int J Epidemiol. 2005;34(2):413–21.CrossRef
14.
go back to reference Palmieri L, Donfrancesco C, Giampaoli S, Trojani M, Panico S, Vanuzzo D, et al. Favorable cardiovascular risk profile and 10-year coronary heart disease incidence in women and men: results from the Progetto CUORE. Eur J Cardiovasc Prev Rehabil. 2006;13(4):562–70.CrossRef Palmieri L, Donfrancesco C, Giampaoli S, Trojani M, Panico S, Vanuzzo D, et al. Favorable cardiovascular risk profile and 10-year coronary heart disease incidence in women and men: results from the Progetto CUORE. Eur J Cardiovasc Prev Rehabil. 2006;13(4):562–70.CrossRef
15.
go back to reference Donfrancesco C, Palmieri L, Cooney MT, Vanuzzo D, Panico S, Cesana G, et al. Italian cardiovascular mortality charts of the CUORE project: are they comparable with the SCORE charts? Eur J Cardiovasc Prev Rehabil. 2010;17(4):403–9.CrossRef Donfrancesco C, Palmieri L, Cooney MT, Vanuzzo D, Panico S, Cesana G, et al. Italian cardiovascular mortality charts of the CUORE project: are they comparable with the SCORE charts? Eur J Cardiovasc Prev Rehabil. 2010;17(4):403–9.CrossRef
16.
go back to reference Gandek B, Ware J, Aaronson N, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA project. J Clin Epidemiol. 1998;51(11):1171–8.CrossRef Gandek B, Ware J, Aaronson N, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA project. J Clin Epidemiol. 1998;51(11):1171–8.CrossRef
17.
go back to reference Longo M, Lucci C, Marconi M, Cremonesi G. Cross-sectional epidemiological study to evaluate the cardiovascular profile of a cohort of blood donors. Blood Transfus. 2007;5(3):153–7.PubMedPubMedCentral Longo M, Lucci C, Marconi M, Cremonesi G. Cross-sectional epidemiological study to evaluate the cardiovascular profile of a cohort of blood donors. Blood Transfus. 2007;5(3):153–7.PubMedPubMedCentral
18.
go back to reference Donfrancesco C, Palmieri L, Vanuzzo D, et al. Italian cardiovascular mortality charts of the CUORE project: are they comparable with the SCORE charts? [article in Italian]. G Ital Cardiol. 2010;11(2):148–53. Donfrancesco C, Palmieri L, Vanuzzo D, et al. Italian cardiovascular mortality charts of the CUORE project: are they comparable with the SCORE charts? [article in Italian]. G Ital Cardiol. 2010;11(2):148–53.
19.
go back to reference Di Castelnuovo A, Costanzo S, Persichillo M, Olivieri M, de Curtis A, Zito F, et al. Distribution of short and lifetime risks for cardiovascular disease in Italians. Eur J Prev Cardiol. 2012;19(4):723–30.CrossRef Di Castelnuovo A, Costanzo S, Persichillo M, Olivieri M, de Curtis A, Zito F, et al. Distribution of short and lifetime risks for cardiovascular disease in Italians. Eur J Prev Cardiol. 2012;19(4):723–30.CrossRef
20.
go back to reference Palmieri L, Rielli R. Dematte` L, Donfrancesco C, Ciccarelli P, De Sanctis Caiola P, et al. CUORE project: implementation of the 10-year risk score. Eur J Cardiovasc Prev Rehabil. 2011;18(4):642–9.CrossRef Palmieri L, Rielli R. Dematte` L, Donfrancesco C, Ciccarelli P, De Sanctis Caiola P, et al. CUORE project: implementation of the 10-year risk score. Eur J Cardiovasc Prev Rehabil. 2011;18(4):642–9.CrossRef
21.
go back to reference Longo M, Palmieri L, Marconi M, Giampaoli S, Cremonesi G, Rebulla P, et al. A new setting of opportunistic cardiovascular screening: from blood donation to preventive cardiology. Preliminary results of the Cardiorisk program [article in Italian]. G Ital Cardiol. 2010;11(7–8):578–83. Longo M, Palmieri L, Marconi M, Giampaoli S, Cremonesi G, Rebulla P, et al. A new setting of opportunistic cardiovascular screening: from blood donation to preventive cardiology. Preliminary results of the Cardiorisk program [article in Italian]. G Ital Cardiol. 2010;11(7–8):578–83.
22.
go back to reference Dell'Anna P, Adorni D, Bernuzzi G, Cantarelli S, Cepparulo A, Cocchi T, et al. Evaluation of cardiovascular risk in blood donors: results of the CARDIORISK study in the Parma transfusion service. Blood Transfus. 2010;8(3):155–8.PubMedPubMedCentral Dell'Anna P, Adorni D, Bernuzzi G, Cantarelli S, Cepparulo A, Cocchi T, et al. Evaluation of cardiovascular risk in blood donors: results of the CARDIORISK study in the Parma transfusion service. Blood Transfus. 2010;8(3):155–8.PubMedPubMedCentral
23.
go back to reference Peffer K, den Heijer M, de Kort WLAM, Verbeek ALM, Atsma F. Cardiovascular risk in 159 934 frequent blood donors while addressing the healthy donor effect. Heart. 2019;0:1–6. Peffer K, den Heijer M, de Kort WLAM, Verbeek ALM, Atsma F. Cardiovascular risk in 159 934 frequent blood donors while addressing the healthy donor effect. Heart. 2019;0:1–6.
24.
go back to reference Clarke R, Daly L, Robinson K, Naughten E, Cahalane S, Fowler B, et al. Hyperhomocysteinemia: an independent risk factor for vascular disease. N Engl J Med. 1991;324(17):1149–55.CrossRef Clarke R, Daly L, Robinson K, Naughten E, Cahalane S, Fowler B, et al. Hyperhomocysteinemia: an independent risk factor for vascular disease. N Engl J Med. 1991;324(17):1149–55.CrossRef
25.
go back to reference Santilli F, Davì G, Patrono C. Homocysteine, methylenetetrahydrofolate reductase, folate status and atherothrombosis: a mechanistic and clinical perspective. Vasc Pharmacol. 2016;78:1–9.CrossRef Santilli F, Davì G, Patrono C. Homocysteine, methylenetetrahydrofolate reductase, folate status and atherothrombosis: a mechanistic and clinical perspective. Vasc Pharmacol. 2016;78:1–9.CrossRef
26.
go back to reference Kassner U, Schlabs T, Rosada A, Steinhagen-Thiessen E. Lipoprotein(a)-an independent causal risk factor for cardiovascular disease and current therapeutic options. Atheroscler Suppl. 2015;18:263–7.CrossRef Kassner U, Schlabs T, Rosada A, Steinhagen-Thiessen E. Lipoprotein(a)-an independent causal risk factor for cardiovascular disease and current therapeutic options. Atheroscler Suppl. 2015;18:263–7.CrossRef
27.
go back to reference Jacobson TA. Lipoprotein(a). Cardiovascular disease, and contemporary management. Mayo Clin Proc. 2013;88(11):1294–311.CrossRef Jacobson TA. Lipoprotein(a). Cardiovascular disease, and contemporary management. Mayo Clin Proc. 2013;88(11):1294–311.CrossRef
28.
go back to reference Saeedi R, Frohlich J. Lipoprotein (a), an independent cardiovascular risk marker. Clin Diabetes Endocrinol. 2016;31:2–7. Saeedi R, Frohlich J. Lipoprotein (a), an independent cardiovascular risk marker. Clin Diabetes Endocrinol. 2016;31:2–7.
29.
go back to reference Uche E, Adediran A, Damulak O, et al. Lipid profile of regular blood donors. J Blood Med. 2013;10(4):39–42. Uche E, Adediran A, Damulak O, et al. Lipid profile of regular blood donors. J Blood Med. 2013;10(4):39–42.
30.
go back to reference Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, et al. American Heart Association Council on quality of care and outcomes research, council on epidemiology and prevention, council on cardiovascular and stroke nursing, council on lifestyle and Cardiometabolic health, and stroke council. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132(9):873–98.CrossRef Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, et al. American Heart Association Council on quality of care and outcomes research, council on epidemiology and prevention, council on cardiovascular and stroke nursing, council on lifestyle and Cardiometabolic health, and stroke council. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132(9):873–98.CrossRef
31.
go back to reference Meng X, D'Arcy C. Education and dementia in the context of the cognitive reserve hypothesis: a systematic review with meta-analyses and qualitative analyses. PLoS One. 2012;7(6):e38268.CrossRef Meng X, D'Arcy C. Education and dementia in the context of the cognitive reserve hypothesis: a systematic review with meta-analyses and qualitative analyses. PLoS One. 2012;7(6):e38268.CrossRef
32.
33.
go back to reference Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002;8(3):448–60.CrossRef Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002;8(3):448–60.CrossRef
34.
go back to reference Silventoinen K, Pankow J, Jousilahti P, Hu G, Tuomilehto J, et al. Educational inequalities in the metabolic syndrome and coronary heart disease among middle-aged men and women. Int J Epidemiol. 2005;34(2):327–34.CrossRef Silventoinen K, Pankow J, Jousilahti P, Hu G, Tuomilehto J, et al. Educational inequalities in the metabolic syndrome and coronary heart disease among middle-aged men and women. Int J Epidemiol. 2005;34(2):327–34.CrossRef
35.
go back to reference Méjean C, Droomers M, van der Schouw YT, Sluijs I, Czernichow S, Grobbee DE, et al. The contribution of diet and lifestyle to socioeconomic inequalities in cardiovascular morbidity and mortality. Int J Cardiol. 2013;168(6):5190–5.CrossRef Méjean C, Droomers M, van der Schouw YT, Sluijs I, Czernichow S, Grobbee DE, et al. The contribution of diet and lifestyle to socioeconomic inequalities in cardiovascular morbidity and mortality. Int J Cardiol. 2013;168(6):5190–5.CrossRef
36.
go back to reference Kershaw KN, Droomers M, Robinson WR, Carnethon MR, Daviglus ML, Monique Verschuren WM. Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study. Eur J Epidemiol. 2013;28(10):807–14.CrossRef Kershaw KN, Droomers M, Robinson WR, Carnethon MR, Daviglus ML, Monique Verschuren WM. Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study. Eur J Epidemiol. 2013;28(10):807–14.CrossRef
37.
go back to reference Verones G, Ferrario MM, Kuulasmaa K, Bobak M, Chambless LE, Salomaa V, et al. Educational class inequalities in the incidence of coronary heart disease in Europe. Heart. 2016;102(12):958–65.CrossRef Verones G, Ferrario MM, Kuulasmaa K, Bobak M, Chambless LE, Salomaa V, et al. Educational class inequalities in the incidence of coronary heart disease in Europe. Heart. 2016;102(12):958–65.CrossRef
38.
go back to reference Nordahl H, Rod NH, Frederiksen BL, Andersen I, Lange T, Diderichsen F, et al. Education and risk of coronary heart disease: assessment of mediation by behavioral risk factors using the additive hazards model. Eur J Epidemiol. 2013;28(2):149–57.CrossRef Nordahl H, Rod NH, Frederiksen BL, Andersen I, Lange T, Diderichsen F, et al. Education and risk of coronary heart disease: assessment of mediation by behavioral risk factors using the additive hazards model. Eur J Epidemiol. 2013;28(2):149–57.CrossRef
39.
go back to reference Lynch JW, Rod NH, Frederiksen BL, Tuomilehto J, Salonen JT. Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol. 1996;144(10):934–42.CrossRef Lynch JW, Rod NH, Frederiksen BL, Tuomilehto J, Salonen JT. Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol. 1996;144(10):934–42.CrossRef
40.
go back to reference Kuper H, Adami HO, Theorell T, Weiderpass E. Psychosocial determinants of coronary heart disease in middle-aged women: a prospective study in Sweden. Am J Epidemiol. 2006;164(4):349–57.CrossRef Kuper H, Adami HO, Theorell T, Weiderpass E. Psychosocial determinants of coronary heart disease in middle-aged women: a prospective study in Sweden. Am J Epidemiol. 2006;164(4):349–57.CrossRef
41.
go back to reference Marmot MG, Shipley MJ, Hemingway H, Head J, Brunner EJ. Biological and behavioural explanations of social inequalities in coronary heart disease: Whitehall II study. Diabetologia. 2008;51(11):1980–8.CrossRef Marmot MG, Shipley MJ, Hemingway H, Head J, Brunner EJ. Biological and behavioural explanations of social inequalities in coronary heart disease: Whitehall II study. Diabetologia. 2008;51(11):1980–8.CrossRef
42.
go back to reference Strand BH, Tverdal A. Can cardiovascular risk factors and lifestyle explain the educational inequalities in mortality from ischaemic heart disease and from other heart diseases? 26 year follow up of 50,000 Norwegian men and women. J Epidemiol Community Health. 2004;58(8):705–9.CrossRef Strand BH, Tverdal A. Can cardiovascular risk factors and lifestyle explain the educational inequalities in mortality from ischaemic heart disease and from other heart diseases? 26 year follow up of 50,000 Norwegian men and women. J Epidemiol Community Health. 2004;58(8):705–9.CrossRef
43.
go back to reference Van Lenthe FJ, Gevers E, Joung IM, Bosma H, Mackenbach JP. Material and behavioural factors in the explanation of educational differences in incidence of acute myocardial infarction: the globe study. Ann Epidemiol. 2002;12(8):535–42.CrossRef Van Lenthe FJ, Gevers E, Joung IM, Bosma H, Mackenbach JP. Material and behavioural factors in the explanation of educational differences in incidence of acute myocardial infarction: the globe study. Ann Epidemiol. 2002;12(8):535–42.CrossRef
44.
go back to reference Floud S, Balkwill A, Moser K, Reeves GK, Green J, Beral V, et al. The role of health-related behavioural factors in accounting for inequalities in coronary heart disease risk by education and area deprivation: prospective study of 1.2 million UK women. BMC Med. 2016;14(1):145.CrossRef Floud S, Balkwill A, Moser K, Reeves GK, Green J, Beral V, et al. The role of health-related behavioural factors in accounting for inequalities in coronary heart disease risk by education and area deprivation: prospective study of 1.2 million UK women. BMC Med. 2016;14(1):145.CrossRef
Metadata
Title
Homocysteine and education but not lipoprotein (a) predict estimated 10-year risk of cardiovascular disease in blood donors: a community based cross-sectional study
Authors
Francesco Vadini
Francesca Santilli
Giuseppe Casalini
Mario dell’Isola
Ornella Iuliani
Damiano D’Ardes
Luisa Lattanzio
Marta Di Nicola
Giancarlo Di Iorio
Patrizia Accorsi
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2019
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-019-1157-5

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