Education Level Not Predictive of CV Risk in All Countries

Inverse association in high-income regions does not always hold in low-income regions
By Lindsey Marcellin
HealthDay Reporter

WEDNESDAY, Sept. 8 (HealthDay News) -- The protective effect of higher attained educational level (AEL) on cardiovascular outcomes reported for high-income countries (HICs) may not hold true for low- and middle-income countries (LMICs), especially for women, according to a study published online Sept. 7 in Circulation.

Abhinav Goyal, M.D., of the Emory Rollins School of Public Health in Atlanta, and colleagues conducted a prospective study of 67,888 participants included in the Reduction of Atherothrombosis for Continued Health (REACH) Registry from 44 countries. At baseline, 61,332 subjects reported AEL. All subjects had either established disease or multiple atherothrombotic risk factors at baseline, and were followed for 23 months for incident cardiovascular events.

The researchers found that, in the study group as a whole, education was inversely associated with diabetes mellitus and directly associated with hypercholesterolemia. For other risk factors, including obesity, smoking, hypertension, and burden of vascular disease at baseline, AEL was found to be protective in HICs but not in LMICs. When stratified by income level, the strongest protective effect of higher AEL was in males from HICs (P < 0.0001); the effect was more modest in women from HICs (P = 0.0026) and in men from LMICs (P = 0.082). There was no significant protective effect of AEL in women from LMICs (P = 0.32).

"Higher AEL may promote better health outcomes through multiple mechanisms, including higher personal income, improved access to health care, better health literacy and adherence to therapies, and adoption of healthier behaviors. However, in LMICs, higher AEL may not confer these benefits equally to women and men; women may be less independent or empowered than men to make healthy lifestyle choices or to seek adequate health care," the authors write.

The REACH Registry is sponsored partly by Sanofi-Aventis and Bristol-Myers Squibb. Two authors disclosed financial relationships with pharmaceutical and medical device companies, including study sponsors.

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