RT Journal Article SR Electronic T1 Roles of allostatic load, lifestyle and clinical risk factors in mediating the association between education and coronary heart disease risk in Europe JF Journal of Epidemiology and Community Health JO J Epidemiol Community Health FD BMJ Publishing Group Ltd SP jech-2020-215394 DO 10.1136/jech-2020-215394 A1 Blánaid Hicks A1 Giovanni Veronesi A1 Marco M Ferrario A1 Hannah Forrest A1 Margaret Whitehead A1 Finn Diderichsen A1 Hugh Tunstall-Pedoe A1 Kari Kuulasmaa A1 Susana Sans A1 Veikko Salomaa A1 Barbara Thorand A1 Annette Peters A1 Stefan Soderberg A1 Giancarlo Cesana A1 Martin Bobak A1 Licia Iacoviello A1 Luigi Palmieri A1 Tanja Zeller A1 Stefan Blankenberg A1 Frank Kee A1 , YR 2021 UL http://jech.bmj.com/content/early/2021/06/17/jech-2020-215394.abstract AB Background Previous studies have shown that differential exposure to lifestyle factors may mediate the association between education and coronary heart diseases (CHD). However, few studies have examined the potential roles of allostatic load (AL) or differential susceptibility.Methods 25 310 men and 26 018 women aged 35–74 and CHD free at baseline were identified from 21 European cohorts and followed for a median of 10 years, to investigate the mediating role of AL, as well as of smoking, alcohol use and body mass index (BMI), on educational differences in CHD incidence, applying marginal structural models and three-way decomposition.Results AL is a mediator of the association between educational status and CHD incidence, with the highest proportion mediated observed among women and largely attributable to differential exposure, (28% (95% CI 19% to 44%)), with 8% (95% CI 0% to 16%) attributable to differential susceptibility. The mediating effects of smoking, alcohol and BMI, compared with AL, were relatively small for both men and women.Conclusion Overall, the educational inequalities in CHD incidence were partially mediated through differential exposure to AL. By contrast, the mediation of the educational gradient in CHD by investigated lifestyle risk factors was limited. As differential susceptibility in men was found to have a predominant role in the accumulation of AL in low educational classes, the investigation of AL-related risk factors is warranted.No additional data are available from each of the cohorts. Data may be made available to researchers upon reasonable request.