Lower Education Level Is Associated with Higher Risk for Cardiovascular Disease

Authors: Adler NE and Glymour M., JAMA Intern Med 2017 Jun 12;

More than half of adults who didn’t complete high school had adverse CV events during their lifetimes.

Educational attainment is associated with risk for cardiovascular disease (CVD), presumably as a marker or mediator of other traditional risk factors. To clarify the magnitude of this risk, researchers examined population-based data from about 14,000 U.S. adults (age range, 45–64; 27% black) who were free of CVD at baseline. Educational attainment was categorized in six levels ranging from grade school to graduate or professional school. Participants were followed for a median 19 years; about 4500 incident CVD events occurred.

Lifetime risk for CVD was correlated inversely with educational attainment level; for example, overall lifetime risks among those with only grade school educations, those who graduated from high school, and those with graduate or professional school educations were 55%, 42%, and 36%, respectively. Analyses by sex and race showed similar inverse correlations. In graded fashion, traditional CV risk factors were less common at higher education levels, but the analysis did not adjust for these baseline differences.

In this analysis, lower education level was associated with greater risk for CVD. Adults in this study with lower education levels also had less access to medical care, lower levels of physical activity, higher levels of smoking, poorer diets, greater prevalence of hypertension and diabetes, and fewer economic resources. Thus, the association between education level and CVD likely was mediated by many other clinical and nonclinical factors. Nevertheless, knowing a patient’s level of educational attainment might improve overall clinical risk assessment by drawing more attention to modifiable risk factors.