Participants with a university degree had a significantly lower risk of cardiovascular disease incidence (HR 0.51) compared to those with primary or lower education, with 26% of this association mediated by hypertension, BMI, and diabetes.
Cohort (n=9,226)
Does a university degree reduce cardiovascular disease incidence in participants without previous cardiovascular disease compared to primary or lower education?
The protective effect of higher education against cardiovascular disease incidence is partially mediated by modifiable risk factors including hypertension, BMI, and diabetes.
Effect estimate: HR 0.51 (95% CI 0.30-0.85)
Absolute Event Rate: 2.2% vs 5.7%
Education and cardiovascular disease (CVD) are inversely associated but the mediating factors have not been totally elucidated. Our aim was to analyze the mediating role of modifiable risk factors. Cohort study using the REGICOR population cohorts. Participants without previous CVD were included (n = 9226). Marginal structural models were used to analyze the association between education and CVD incidence at 6 years of follow-up. Mediation by modifiable risk factors (diabetes, dyslipidemia, hypertension, smoking, body mass index, and physical activity) was assessed using the counterfactual framework. Participants with a university degree had a CVD incidence hazard ratio (HR) of 0.51 (95% confidence interval (CI) = 0.30, 0.85), compared to those with primary or lower education. Only hypertension, BMI, and diabetes mediated the association between education and CVD incidence, accounting for 26% of the association (13.9, 6.9, and 5.2%, respectively). Sensitivity analyses showed that hypertension was the strongest mediator (average causal mediation effect 95% CI = increase of 2170 days free of CVD events 711, 4520). The association between education and CVD incidence is partially mediated by hypertension, BMI, and diabetes. Interventions to decrease the prevalence of these risk factors could contribute to diminish the CVD inequalities associated with educational level.
Dégano et al. (Fri,) conducted a cohort in Cardiovascular disease (n=9,226). University education vs. Primary or lower education was evaluated on 6-year cardiovascular disease incidence (HR 0.51, 95% CI 0.30-0.85). Participants with a university degree had a significantly lower risk of cardiovascular disease incidence (HR 0.51) compared to those with primary or lower education, with 26% of this association mediated by hypertension, BMI, and diabetes.