Should Years of Schooling Be Used to Guide Treatment of Coronary Risk Factors?

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Free of coronary heart disease (n=6479). Intervention: Less than 12 years of education vs. More than 12 years of education. Primary outcome: Death within 10 years from coronary heart disease (RR 1.5, 95% CI 1.2-1.8).

Q: What does this research mean for the field?

Having less than 12 years of education is associated with a 1.5-fold increased risk of 10-year coronary heart disease mortality, an increase comparable in magnitude to established cardiovascular risk factors such as smoking and hypercholesterolemia. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kevin A Fiscella

doi:10.1370/afm.88

September 1, 2004The Annals of Family MedicineOpen Access

Should Years of Schooling Be Used to Guide Treatment of Coronary Risk Factors?

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Why the study?

Low educational level as a measure of socioeconomic status may confer coronary heart disease mortality risk comparable to established risk factors, but its role in guiding treatment is unclear.

Study Design

Type

Cohort (n=6,479)

PICO

P

Population

6,479 adults aged 25 to 74 years in the United States, free of coronary heart disease at baseline, followed for 10 years to assess mortality risk.

E

Exposure / Comparator

Less than 12 years of education vs More than 12 years of education

O

Primary Outcome

Death within 10 years from coronary heart disease — RR 1.5 (1.2-1.8)

Main Result

Relative Risk: 1.5 (95% CI 1.2–1.8)

Absolute Event Rate: 3.4% vs 1.8%

Limitations

Baseline assessments were obtained more than 25 years ago, and the relationship between socioeconomic status and CHD could have changed.
Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels were not assessed.
Unmeasured non-traditional CHD risk factors (e.g., fibrinogen, C-reactive protein) were not included in the analysis.
Potential for greater modification in traditional risk factors (e.g., smoking cessation) among more educated persons after baseline assessment.
Observational study design cannot definitively establish that using a lower treatment threshold for less-educated persons improves outcomes.

Abstract

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Discussion

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Cite This Study

Kevin A Fiscella (2004) conducted a cohort in Free of coronary heart disease (n=6,479). Less than 12 years of education vs. More than 12 years of education was evaluated on Death within 10 years from coronary heart disease (RR 1.5, 95% CI 1.2-1.8).

synapsesocial.com/papers/6ac48952806e9f020b281fc3 https://doi.org/10.1370/afm.88

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Should Years of Schooling Be Used to Guide Treatment of Coronary Risk Factors?

Study Design

PICO

Main Result

Limitations

Abstract

Discussion

Cite This Study

Should Years of Schooling Be Used to Guide Treatment of Coronary Risk Factors?

Study Design

PICO

Main Result

Limitations

Abstract

Discussion

Cite This Study

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