{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:29:25Z","timestamp":1790602165793,"version":"4.1.0"},"reference-count":38,"publisher":"BMJ","issue":"7","funder":[{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["award number 667661, project MINDMAP"],"award-info":[{"award-number":["award number 667661, project MINDMAP"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005633","name":"Finnish Foundation for Cardiovascular Research","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100005633","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"publisher","award":["308247"],"award-info":[{"award-number":["308247"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"publisher","award":["321356"],"award-info":[{"award-number":["321356"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2020,12,16]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Genetic vulnerability to coronary heart disease (CHD) is well established, but little is known whether these effects are mediated or modified by equally well-established social determinants of CHD. We estimate the joint associations of the polygenetic risk score (PRS) for CHD and education on CHD events.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The data are from the 1992, 1997, 2002, 2007 and 2012 surveys of the population-based FINRISK Study including measures of social, behavioural and metabolic factors and genome-wide genotypes (N=26 203). Follow-up of fatal and non-fatal incident CHD events (N=2063) was based on nationwide registers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Allowing for age, sex, study year, region of residence, study batch and principal components, those in the highest quartile of PRS for CHD had strongly increased risk of CHD events compared with the lowest quartile (HR=2.26; 95% CI: 1.97 to 2.59); associations were also observed for low education (HR=1.58; 95% CI: 1.32 to 1.89). These effects were largely independent of each other. Adjustment for baseline smoking, alcohol use, body mass index, igh-density lipoprotein (HDL) and total cholesterol, blood pressure and diabetes attenuated the PRS associations by 10% and the education associations by 50%. We do not find strong evidence of interactions between PRS and education.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>PRS and education predict CHD events, and these associations are independent of each other. Both can improve CHD prediction beyond behavioural risks. The results imply that observational studies that do not have information on genetic risk factors for CHD do not provide confounded estimates for the association between education and CHD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2020-214358","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T16:05:11Z","timestamp":1609949111000},"page":"651-657","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Joint association between education and polygenic risk score for incident coronary heart disease events: a longitudinal population-based study of 26 203 men and women"],"prefix":"10.1136","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9374-1438","authenticated-orcid":false,"given":"Pekka","family":"Martikainen","sequence":"first","affiliation":[{"name":"Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Finland"},{"name":"Centre for Health Equity Studies, Stockholm University, Stockholm, Sweden"},{"name":"Max Planck Institute for Demographic Research, Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaarina","family":"Korhonen","sequence":"additional","affiliation":[{"name":"Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline","family":"Jelenkovic","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of the Basque Country, Bilbao, Pa\u00eds Vasco, Spain"},{"name":"Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0910-823X","authenticated-orcid":false,"given":"Hannu","family":"Lahtinen","sequence":"additional","affiliation":[{"name":"Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aki","family":"Havulinna","sequence":"additional","affiliation":[{"name":"Institute for Molecular Medicine Finland, Helsinki, Finland"},{"name":"Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuli","family":"Ripatti","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland"},{"name":"Institute for Molecular Medicine Finland, Helsinki, Finland"},{"name":"Broad Institute of MIT and Harvard, Cambridge, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Borodulin","sequence":"additional","affiliation":[{"name":"Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland"},{"name":"Age Institute, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veikko","family":"Salomaa","sequence":"additional","affiliation":[{"name":"Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Davey Smith","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, University of Bristol, Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1759-3079","authenticated-orcid":false,"given":"Karri","family":"Silventoinen","sequence":"additional","affiliation":[{"name":"Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,1,6]]},"reference":[{"key":"2025100304395703000_75.7.651.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61728-0"},{"key":"2025100304395703000_75.7.651.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0707519"},{"key":"2025100304395703000_75.7.651.3","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/S0140-6736(05)17867-2","article-title":"Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight Western European populations","volume":"365","author":"Huisman","year":"2005","journal-title":"The Lancet"},{"key":"2025100304395703000_75.7.651.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7145.1636"},{"key":"2025100304395703000_75.7.651.5","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.socscimed.2017.01.055","article-title":"Early-Life and adult socioeconomic determinants of myocardial infarction incidence and fatality","volume":"177","author":"Kilpi","year":"2017","journal-title":"Soc Sci Med"},{"key":"2025100304395703000_75.7.651.6","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxm001"},{"key":"2025100304395703000_75.7.651.7","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyi007"},{"key":"2025100304395703000_75.7.651.8","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2012.00029","article-title":"Variability in the heritability of body mass index: a systematic review and meta-regression","volume":"3","author":"Elks","year":"2012","journal-title":"Front Endocrinol"},{"key":"2025100304395703000_75.7.651.9","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.117.153643"},{"key":"2025100304395703000_75.7.651.10","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1375\/136905203770326439","article-title":"The genetics of coronary heart disease: the contribution of twin studies","volume":"6","author":"Evans","year":"2003","journal-title":"Twin Research"},{"key":"2025100304395703000_75.7.651.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-007-0758-1"},{"key":"2025100304395703000_75.7.651.12","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1056\/NEJM199404143301503","article-title":"Genetic susceptibility to death from coronary heart disease in a study of twins","volume":"330","author":"Marenberg","year":"1994","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025100304395703000_75.7.651.13","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2796.2002.01029.x"},{"key":"2025100304395703000_75.7.651.14","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1093\/ije\/dyx012","article-title":"Family aggregation of cardiovascular disease mortality: a register-based prospective study of pooled Nordic twin cohorts","volume":"46","author":"Silventoinen","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2025100304395703000_75.7.651.15","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1093\/cvr\/cvx019","article-title":"Partitioning the heritability of coronary artery disease highlights the importance of immune-mediated processes and epigenetic sites associated with transcriptional activity","volume":"113","author":"Nikpay","year":"2017","journal-title":"Cardiovasc Res"},{"key":"2025100304395703000_75.7.651.16","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-019-0465-0"},{"key":"2025100304395703000_75.7.651.17","doi-asserted-by":"publisher","DOI":"10.1038\/ng.3396"},{"key":"2025100304395703000_75.7.651.18","doi-asserted-by":"publisher","DOI":"10.1038\/ng.2797"},{"key":"2025100304395703000_75.7.651.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2019.03.028"},{"key":"2025100304395703000_75.7.651.20","first-page":"113","article-title":"A genetic risk score is associated with incident cardiovascular disease and coronary artery calcium: the Framingham heart study","volume":"5","author":"Thanassoulis","year":"2012","journal-title":"Circulation: Genomic and Precision Medicine"},{"key":"2025100304395703000_75.7.651.21","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw450"},{"key":"2025100304395703000_75.7.651.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgen.1003607","article-title":"Gene \u00d7 physical activity interactions in obesity: combined analysis of 111,421 individuals of European ancestry","volume":"9","author":"Ahmad","year":"2013","journal-title":"PLoS Genet"},{"key":"2025100304395703000_75.7.651.23","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2009.27689"},{"key":"2025100304395703000_75.7.651.24","first-page":"559","article-title":"Gene-obesogenic environment interactions in the UK Biobank study","volume":"46","author":"Tyrrell","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2025100304395703000_75.7.651.25","doi-asserted-by":"crossref","unstructured":"Young AI , Wauthier F , Donnelly P . Multiple novel gene-by-environment interactions modify the effect of FTO variants on body mass index. Nat Commun 2016;7.doi:10.1038\/ncomms12724","DOI":"10.1038\/ncomms12724"},{"key":"2025100304395703000_75.7.651.26","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyx239"},{"key":"2025100304395703000_75.7.651.27","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv462"},{"key":"2025100304395703000_75.7.651.28","first-page":"132","article-title":"The validity of the Finnish hospital discharge register and causes of death register data on coronary heart disease","volume":"12","author":"Pajunen","year":"2005","journal-title":"European Journal of Cardiovascular Prevention & Rehabilitation"},{"key":"2025100304395703000_75.7.651.29","unstructured":"StataCorp . Stata statistical software: release 14. College Station, TX: StataCorp LP, 2015."},{"key":"2025100304395703000_75.7.651.30","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1038\/s41591-020-0800-0","article-title":"Polygenic and clinical risk scores and their impact on age at onset and prediction of cardiometabolic diseases and common cancers","volume":"26","author":"Mars","year":"2020","journal-title":"Nat Med"},{"key":"2025100304395703000_75.7.651.31","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/S0140-6736(10)61267-6","article-title":"A multilocus genetic risk score for coronary heart disease: case-control and prospective cohort analyses","volume":"376","author":"Ripatti","year":"2010","journal-title":"The Lancet"},{"key":"2025100304395703000_75.7.651.32","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s00038-016-0922-9","article-title":"Long-Term trends of inequalities in mortality in 6 European countries","volume":"62","author":"de Gelder","year":"2017","journal-title":"Int J Public Health"},{"key":"2025100304395703000_75.7.651.33","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-019-0379-x"},{"key":"2025100304395703000_75.7.651.34","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1105839109"},{"key":"2025100304395703000_75.7.651.35","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j3542"},{"key":"2025100304395703000_75.7.651.36","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2012-201266"},{"key":"2025100304395703000_75.7.651.37","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.healthplace.2017.07.005","article-title":"Determinants of the magnitude of socioeconomic inequalities in mortality: a study of 17 European countries","volume":"47","author":"Mackenbach","year":"2017","journal-title":"Health Place"},{"key":"2025100304395703000_75.7.651.38","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024436"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2020-214358","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T11:40:11Z","timestamp":1759491611000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2020-214358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,6]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,6,10]]},"published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1136\/jech-2020-214358"],"URL":"https:\/\/doi.org\/10.1136\/jech-2020-214358","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,6]]}}}