Associations of educational attainment and traditional risk factor control with cardiovascular disease

Objective: Cardiovascular disease (CVD) incidence is rising globally, with a significant burden in China. Educational attainment, a key socioeconomic factor, is strongly associated with CVD risk, partly due to differences in risk factor management. This study examines the association between educational attainment, cardiovascular risk factor control, and CVD incidence. Methods: This study analyzed data from the Kailuan Study, which enrolled 101,510 participants (2006-2007), with 92,186 meeting the inclusion criteria. Data collection included epidemiological surveys, anthropometric measurements, blood pressure assessments, smoking status evaluations, and biochemical tests. A composite risk factor control score was based on blood pressure, fasting blood glucose, low-density lipoprotein cholesterol, smoking status, and body mass index. Participants were followed until December 31, 2022, with CVD events-including coronary heart disease (CHD) and cerebrovascular disease (CBD)-as study endpoints. Cox proportional hazards models estimated hazard ratios (HRs) and 95 % confidence intervals (CIs), and mediation analysis assessed the role of risk factor control. Results: During a 14.48-year follow-up, 11,145 CVD events occurred. Lower education was associated with higher CVD risk (HR: 1.51, 95 % CI: 1.35-1.69), with risk factor control mediating 14.2 % of this association. Better risk factor management correlated with lower CVD risk, particularly among highly educated individuals. Conclusion: Lower education significantly increases CVD risk, especially among those with poor risk factor control. While risk factor management mitigates some of this risk, its effect is limited, highlighting the need for comprehensive interventions, including improved health education and social support.