Key result
Low educational status was associated with a significantly higher 10-year all-cause mortality compared to high educational status among patients with acute coronary syndrome (40% vs 19%, p<0.001).
Why the study?
Does educational status impact 10-year recurrent ACS events and all-cause mortality in patients with acute coronary syndrome?
Cohort (n=2,172)
Yes
Does educational status impact 10-year recurrent ACS events and all-cause mortality in patients with acute coronary syndrome?
Hazard Ratio: 1.53 (95% CI 1.09–2.12)
Absolute Event Rate: 40% vs 19%
p-value: p=<0.001
Low educational status is associated with significantly higher 10-year all-cause mortality and recurrent ACS events in patients following an initial acute coronary syndrome.
Low education marks higher post-ACS risk; leaves open whether targeted interventions improve outcomes.
OBJECTIVES: The association between educational status and 10-year risk for acute coronary syndrome (ACS) and all-cause mortality was evaluated. METHODS: From October 2003 to September 2004, 2172 consecutive ACS patients from six Greek hospitals were enrolled. In 2013 to 2014, a 10-year follow-up (2004-2014) assessment was performed for 1918 participants (participation rate, 88%). Each patient's educational status was classified as low (<9 years of school), intermediate (9 to 14 years), or high (>14 years). RESULTS: Overall all-cause mortality was almost twofold higher in the low-education group than in the intermediate-education and high-education groups (40% vs. 22% and 19%, respectively, p<0.001). Additionally, 10-year recurrent ACS events (fatal and non-fatal) were more common in the low-education group than in the intermediate-education and high-education groups (42% vs. 30% and 35%, p<0.001), and no interactions between sex and education on the investigated outcomes were observed. Moreover, patients in the high-education group were more physically active, had a better financial status, and were less likely to have hypertension, diabetes, or ACS than the participants with the least education (p<0.001); however, when those characteristics and lifestyle habits were accounted for, no moderating effects regarding the relationship of educational status with all-cause mortality and ACS events were observed. CONCLUSIONS: A U-shaped association may be proposed for the relationship between ACS prognosis and educational status, with participants in the low-education and high-education groups being negatively affected by other factors (e.g., job stress, depression, or loneliness). Public health policies should be aimed at specific social groups to reduce the overall burden of cardiovascular disease morbidity.
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Notara et al. (2016) conducted a cohort in Acute Coronary Syndrome (n=2,172). Low educational status (<9 years of school) vs. High educational status (>14 years of school) was evaluated on All-cause mortality (HR 1.53, 95% CI 1.09-2.12, p=<0.001). Low educational status was associated with a significantly higher 10-year all-cause mortality compared to high educational status among patients with acute coronary syndrome (40% vs 19%, p<0.001).