Gender and employment grade differences in blood cholesterol, apolipoproteins and haemostatic factors in the Whitehall II study

      This paper is only available as a PDF. To read, Please Download here.


      In the first Whitehall study, plasma cholesterol was a strong predictor of coronary heart disease (CHD) but it showed a positive association with grade of employment: the higher the grade.the higher the level. Because it could not explain the higher rate of CHD in lower employment grades, further investigation of biochemical CHD risk factors has been conducted with data from the baseline examination of the Whitehall II cohort in 1985-88. These data also allow investigation of gender differences and the effect of menopause. Serum cholesterol (6860 men and 3374 women) and apolipoproteins A-I and B (apo Al and apo B) were measured in those aged 35–55 working in the London offices of twenty Civil Service departments. Plasma fibrinogen and factor VII were determined in 45–55 year olds. The apo B/apo AI ratio (95% confidence interval) after age adjustment is lowest in premenopausal women: 0.557 (0.549-0.565), intermediate in postmenopausal women: 0.601 (0.589-0.613) and highest in men: 0.703 (0.698-0.709). After age adjustment fibrinogen is higher in postmenopausal (2.90 (2.85-2.95) g/1) than in premenopausal women (2.78 (2.71-2.84) g/1), who have higher levels than men (2.64 (2.62-2.67) g/1). A positive association with employment grade is seen for apo AI and a negative association is seen for fibrinogen, apo B (women only) and the apo B/apo AI ratio, after age adjustment. These patterns are consistent with the higher rates of CHD in lower grades. Cholesterol and factor VII show no gradient with our sensitive measure of social position. After adjusting for the effects of smoking rates, alcohol consumption, exercise and dietary pattern, as well as age, ethnicity, body mass index and report of symptoms, the regression coefficient for apo AI on employment grade is reduced by 43% in men and 70% in women. Corresponding reductions for fibrinogen are 53% and 65%. These attenuations suggest that a considerable part of the social gradients in apo AI and fibrinogen are explained by variations in health related behaviours. The remaining gradients may represent effects independent of these behaviours.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Office of Population Censuses and Surveys
        Mortality Statistics 1988: Cause (Series DH2).
        HMSO, London1990
        • Marmot M.G.
        • Booth M.
        • Beral V.
        Changes in heart disease mortality in England and Wales and other countries.
        Health Trends,. 1981; 13: 33
        • Marmot M.G.
        • McDowall M.E.
        Mortality decline and widening social inequalities.
        Lancet. 1986; i: 274
        • Pocock S.J.
        • Shaper A.G.
        • Cook D.G.
        • Phillips A.N.
        • Walker M.
        Social class differences in ischaemic heart disease in British men.
        Lancet. 1987; ii: 197
        • Hein H.O.
        • Suadicani P.
        • Gyntelberg F.
        Ischaemic heart disease incidence by social class and form of smoking: the Copenhagen male study - 17 years' follow-up.
        J. Int. Med. 1992; 231: 477
        • Davey Smith G.
        • Bartley M.
        • Blane D.
        The Black report on socioeconomic inequalities in health 10 years on.
        Br. Med. J. 1990; 301: 373
        • Rosengren A.
        Coronary heart disease and mortality in middle aged men from different occupational classes in Sweden.
        Br. Med. J. 1988; 297: 1497
        • Holme I.
        • Helgeland A.
        • Hjermann I.
        • Leren P.
        • Lund-Larson P.G.
        Four-year mortality by some socioeconomic indicators: the Oslo study.
        J. Epidemiol. Comm. Health. 1980; 34: 48
        • Marmot M.G.
        • Davey Smith G.
        • Stansfeld S.
        • Patel C.
        • North F.
        • Head J.
        • White I.
        • Brunner E.J.
        • Feeney A.
        Health inequalities among British civil servants: the Whitehall II Study.
        Lancet. 1991; 337: 1387
        • Davey Smith G.
        • Shipley M.J.
        • Marmot M.G.
        • Rose G.
        Plasma cholesterol concentration and Mortality: The Whitehall Study.
        J. Am. Med. Assoc. 1992; 267: 70
        • Rose G.
        • Marmot M.G.
        Social class and coronary heart disease.
        Br. Heart J. 1981; 45: 13
        • Mount J.N.
        • Kearney E.M.
        • Rosseneu M.
        • Slavin B.M.
        Immunoturbidimetric assays for serum apolipoproteins Al and B using Cobas Bio centrifugal analyser.
        J. Clin. Pathol. 1988; 41: 471
        • Clauss A.
        Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens.
        Acta Haematol. 1957; 17: 237
        • Brozovic M.
        • Stirling Y.
        • Harricks C.
        • North W.R.S.
        • Meade T.W.
        Factor VII in an industrial population.
        Br. J. Haematol. 1974; 28: 381
        • Stuart J.
        • Lewis S.M.
        Monitoring the acute phase response. Alternative tests to measuring erythrocyte sedimentation rate.
        Br. Med. J. 1988; 297: 1143
        • Hjortland M.C.
        • McNamara P.M.
        • Kannel W.B.
        Some atherogenic concomitants of menopause: the Framingham study.
        Am. J. Epidemiol. 1976; 103: 304
        • Matthews K.A.
        • Meilahn E.
        • Kuller L.H.
        • Kelsey S.F.
        • Gaggiula A.W.
        • Wing R.R.
        Menopause and risk factors for coronary heart disease.
        N. Engl. J. Med. 1989; 321: 641
        • Bonithon-Kopp C.
        • Scarabin P.
        • Darne B.
        • Malmejac A.
        • Guize L.
        Menopause-related changes in lipoproteins and some other cardiovascular risk factors.
        Int. J. Epidemiol. 1990; 19: 42
        • Meade T.W.
        • North W.R.S.
        • Chakrabarti R.
        • Haines A.P.
        • Stirling Y.
        Population-based distributions of haemostatic variables.
        Br. Med. Bull. 1977; 33: 283
        • Kannel W.B.
        • Wolf P.A.
        • Castelli W.P.
        • D'Agostino R.B.
        Fibrinogen and risk of cardiovascular disease.
        J. Am. Med. Assoc. 1987; 258: 1183
        • Balleisen L.
        • Bailey J.
        • Epping P.-H.
        • Schulte J.
        • van de Loo J.
        Epidemiological study on Factor VII, Factor VIII and fibrinogen in an industrial population.
        Thromb. Haemostas. 1985; 54: 475
        • Stampfer M.J.
        • Colditz G.A.
        • Willett W.C.
        Postmenopausal estrogen therapy and cardiovascular disease.
        N. Engl. J. Med. 1991; 325: 756
        • Meade T.W.
        • Brozovic M.
        • Chakrabarti M.
        • Haines A.P.
        • Imeson J.D.
        • Mellows S.
        • Miller G.J.
        • North W.R.S.
        • Stirling Y.
        • Thompson S.G.
        Haemostatic function and ischaemic heart disease: principal results of the Northwick Park heart study.
        Lancet. 1986; ii: 533
        • Harris R.B.
        • Weissfeld L.A.
        Gender differences in the reliability of reporting symptoms of angina pectoris.
        J. Clin. Epidemiol. 1991; 44: 1071
        • Waldron I.
        Sex differences in illness incidence, prognosis and mortality: issues and evidence.
        Soc. Sci. Med. 1983; 17: 1107
        • Gordon T.
        • Kannel W.B.
        • Castelli W.P.
        • Dawber T.R.
        Lipoproteins, cardiovascular disease, and death.
        Arch. Intern. Med. 1981; 141: 1128
        • Phillips A.N.
        • Davey Smith G.
        How independent are `independent' effects? Relative risk estimation when correlated exposures are measured imprecisely.
        J. Clin. Epidemiol. 1991; 44: 1223
        • Gregory J.
        • Foster K.
        • Tyler H.
        • Wiseman M.
        The Dietary and Nutritional Survey of British Adults.
        HMSO, London1990
        • Heiss G.
        • Haskell W.
        • Mowery R.
        • Criqui M.H.
        • Brockway M.
        • Tyroler H.A.
        Plasma high-density lipoprotein cholesterol and socioeconomic status.
        Circulation (Supplement IV). 1980; 62: 108
        • Markowe H.L.J.
        • Marmot M.G.
        • Shipley M.J.
        • et al.
        Fibrinogen: a possible link between social class and coronary heart disease.
        Br. Med. J. 1985; 291: 1312
        • Rosengren A.
        • Wilhelmsen L.
        • Welin L.
        • Tsipogianni A.
        • Teger-Nilsson A.
        • Wedel H.
        Social influences and cardiovascular risk factors as determinants of plasma fibrinogen concentration in a general population sample of middle aged men.
        Br. Med. J. 1990; 300: 634
        • Townsend P.
        • Davidson N.
        • Whitehead M.
        Inequalities in health: The Black Report.
        The Health Divide, Penguin, London1990
        • Marmot M.G.
        • Shipley M.J.
        • Rose G.
        Inequalities in death - specific explanations of a general pattern.
        Lancet. 1984; 1: 1003
        • Roberts R.
        • Brunner E.T.
        • White I.
        • Marmot M.G.
        Structure and mobility in the British Civil Service.
        Soc. Sci. Med. 1993; (in press)
        • Davey Smith G.
        • Shipley M.J.
        • Rose G.
        Magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall Study.
        J. Epidemiol. Comm. Health. 1990; 44: 265
        • Berkman L.F.
        • Syme S.L.
        Social networks, host resistance and mortality: a nine-year follow-up of Alameda County residents.
        Am. J. Epidemiol. 1979; 109: 186
        • Siegrist J.
        • Klein D.
        • Grunewald R.
        • Matschinger H.
        Pressure response and heart rate reaction to a mental stress test in a blue-collar population at cardiovascular risk.
        J. Hypertension. 1986; 4: S260
        • Karasek R.
        • Theorell T.
        Healthy work: Stress, Productivity, and the Reconstruction of Working Life.
        Basic Books, New York1990
        • Romon M.
        • Nuttens M.C.
        • Fievet C.
        • et al.
        Increased triglyceride levels in shift workers.
        Am. J. Med. 1992; 93: 259