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Item Differences in the association of cardiovascular risk factors with education: a comparison of Costa Rica (CRELES) and the USA (NHANES)(J Epidemiol Community Health 2010: 64, 2009) Rehkopf, David H.; Dow, William H.; Rosero Bixby, LuisBackground Despite different levels of economic development, Costa Rica and the USA have similar mortalities among adults. However, in the USA there are substantial differences in mortality by educational attainment, and in Costa Rica there are only minor differences. This contrast motivates an examination of behavioural and biological correlates underlying this difference. Methods The authors used data on adults aged 60 and above from the Costa Rican Longevity and Healthy Ageing Study (CRELES) (n¼2827) and from the US National Health and Nutrition Examination Survey (NHANES) (n¼5607) to analyse the cross-sectional association between educational level and the following risk factors for cardiovascular disease (CVD): ever smoked, current smoker, sedentary, high saturated fat, high carbohydrates, high calorie diet, obesity, severe obesity, large waist circumference, HDL cholesterol, LDL cholesterol, triglycerides, hemoglobin A1c, fasting glucose, C-reactive protein, systolic blood pressure and BMI. Results There were significantly fewer hazardous levels of risk biomarkers at higher levels of education for more than half (10 out of 17) of the risk factors in the USA, but for less than a third of the outcomes in Costa Rica (five out of 17). Conclusions These results are consistent with the context-specific nature of educational differences in risk factors for CVD and with a non-uniform nature of association of CVD risk factors with education within countries. Our results also demonstrate that social equity in mortality is achieved without uniform equity in all risk factors.Item Life-course BMI and biomarkers in persons aged 60 years or older: a comparison of the USA and Costa Rica(Public Health Nutrition, vol.22(2), 2019) Rehkopf, David H.; Duong, Andrew; Dow, William H.; Rosero Bixby, LuisObjective: There is a large literature linking current body mass index (BMI) to levels of cardiovascular risk biomarkers, but it is unknown whether measures of BMI earlier in the life course and maximum BMI are predictive of current levels of biomarkers. The objective of this study is to determine how current, maximum and age 25 body mass index among individuals over the age of 60 are associated with their current levels of cardiovascular risk biomarkers. Design: Cross-sectional study with retrospective recall. Setting: Costa Rica (n=821) and the United States (n=4110). Subjects: Nationally representative samples of adults aged 60 and over. Results: We used regression models to examine the relationship between multiple meaures of body mass index with four established cardiovascular risk biomarkers. The most consistent predictor of current levels of systolic blood pressure, triglycerides and HDL cholesterol is current BMI. However, maximum BMI is the strongest predictor of hemoglobin A1c and is also related to HDL cholesterol and triglycerides. Hemoglobin A1c is independent of current BMI. We find that these relationships are consistent between Costa Rica and the United States for hemoglobin A1c and for HDL cholesterol. Conclusions: Current levels of cardiovascular risk biomarkers are not only the product of current levels of BMI, but also of maximum lifetime BMI, in particular for levels of hemoglobin A1c and for HDL cholesterol. Managing maximum obtained BMI over the life course may be most critical for maintaining the healthiest levels of cardiovascular risk.