Educational status predicts death, CV events

A study out of Emory University has revealed a link between education levels and the odds of developing or dying from CVD, with anything under a graduate degree representing a higher risk of heart disease. 

Educational attainment is inversely linked with coronary artery disease (CAD) risk, Heval M. Kelli, MD, and colleagues at the Emory Clinical Cardiovascular Research Institute in Atlanta, wrote in the Journal of the American Heart Association—that much we know. But few studies have dissected the relationship between education and actual CAD outcomes, leaving a gap in our knowledge of how socioeconomic status can influence the course of CVD.

“The association between educational attainment level (EAL) and CAD incidence is often thought to be mediated through modifiable lifestyle-related cardiovascular risk factors, but the exact causal link between low EAL and elevated cardiovascular risk is not completely understood,” Kelli and co-authors wrote in JAHA. “It is plausible that similar to the association between low EAL and incidence CVD among asymptomatic individuals, low educational attainment portends a worse outcome among patients with CAD.”

The team assessed 6,318 patients undergoing cardiac catheterization for CAD analysis, stratifying them by their highest EAL. Of the subjects, 16% reported receiving a graduate education or higher, 42% said they’d received a college education, 38% received a high school education and 4% received an elementary/middle school education.

Kelli and colleagues noted 1,066 all-cause deaths, 812 cardiovascular deaths or non-fatal MIs, and 276 non-fatal MIs over a follow-up period of 4.2 years. Compared to those with a graduate education, people in lower EAL categories saw worse mortality odds:

  • Elementary/middle school education: 52% increased risk of death
  • High school education: 43% increased risk of death
  • College education: 26% increased risk of death

The authors said their findings were similar for the study’s secondary endpoints of non-fatal MI and cardiovascular death.

“This inverse association was persistent and graded throughout various levels of educational attainment from elementary/middle school, high school, college, to graduate education; with the highest adjusted risk observed in those with the lowest EAL,” they wrote. “The impact of having an EAL below college education was similar to having a history of prior MI, such that the all-cause mortality incidence was similar in patients who were college-educated and had a prior MI as those who were not college educated but had no history of MI.”

The team said routine assessment of EAL among patients undergoing cardiac catheterization for evaluation of CAD could be helpful in guiding management and treatment plans for those patients. Still, they wrote, further work needs to explore the utility of incorporating EAL into risk assessment algorithms and strengthen the link between low EAL and adverse outcomes in high-risk patients.