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

Pekka Martikainen, Kaarina Korhonen, Aline Jelenkovic, Hannu Lahtinen, Aki Havulinna, Samuli Ripatti, Katja Borodulin, Veikko Salomaa, George Davey Smith, Karri Silventoinen

Research output: Contribution to journalArticleScientificpeer-review


Background 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. Methods 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. Results 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. Conclusions 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.

Original languageEnglish
JournalJournal of Epidemiology & Community Health
Issue number7
Pages (from-to)651-657
Number of pages7
Publication statusPublished - Jul 2021
MoE publication typeA1 Journal article-refereed

Fields of Science

  • LIFE
  • coronary heart disease
  • education
  • gene environment interactions
  • social epidemiology
  • 5141 Sociology
  • 3142 Public health care science, environmental and occupational health

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