Life course socioeconomic position and ankle-brachial index

The mechanisms by which life course socioeconomic position (SEP) may influence cardiovascular disease (CVD) are not well explored. Objectives were to investigate the association between cumulative life course SEP and an indicator of subclinical atherosclerosis: ankle-brachial index (ABI). Participants (n=1454) were from the Framingham Heart Study Offspring Cohort. Cumulative SEP was calculated by summing scores for childhood SEP (father's education), early adulthood SEP (own education), and active professional life SEP (own occupation). ABI was dichotomized as low (≤1.1) and normal (>1.1 to 1.4). In logistic regression analyses, cumulative SEP was associated with low ABI in men (odds ratio [OR]=2.09, 95% confidence interval [CI]: 1.24,3.51 for low vs. high cumulative SEP score) but not in women (OR=0.94, 95% CI: 0.63,1.38), after adjustment for age and CVD risk markers. This effect was largely explained by the association of own education with low ABI in men and not in women. Father's education and own occupation were not significantly associated with low ABI in men or women. In conclusion, while cumulative SEP was inversely associated with ABI in men, this effect was primarily due to own education.