Higher Educational Attainment Linked to Reduced Heart Disease Risk

Additional childhood education could result in reductions of heart disease risk and improvements in cardiovascular disease (CVD) risk factors across the US.

A recent study found evidence that support established associations between education and reduced smoking, depression, heart disease and improved high-density lipoprotein cholesterol.

"For clinicians and health systems struggling to address disparities in heart disease between the rich and the poor, our findings suggest that cross-sectoral interventions to address social factors like education are important," said lead author Rita Hamad, MD, PhD, assistant professor of family and community medicine with Philip R. Lee Institute for Health Policy Studies.

Investigators used census data on educational attainment during childhood with outcomes in adulthood. Additionally, investigators used cohort data from the 1992 to 2012 waves of the Health and Retirement Study (HRS) and data from the 1971 to 2012 waves of the National Health and Nutrition Examination Survey (NHANES).

Sample size from the HRS group was 30,853 individuals and the NHANES group was made of 44,732. Investigators used least squares models and instrumental variables analysis to assess the data.

Study outcomes included serum biomarkers, anthropometric measures, and self-reported outcomes of CVD and related risk factors. Investigators noted that each outcome represents one or more mechanistic pathways through which education might influence CVD.

Investigators noted that about a third of study participants did not graduate from high school and 34.5% reported CVD. Additionally, each year of additional schooling through high school was associated a 2.5% reduction in occurrence of CVD. They also noted improvements in certain cardiovascular risk factors with each additional year, including reductions of approximately 3% and 5% in smoking and depression, respectively.

Analyses showed that increased educational attainment was associated with reduced heart disease (β −0.025; 95%CI: −0.04, −0.002; P = 0.01), smoking (β −0.036; 95%CI: −0.06, −0.02; P < 0.01), and depression (β −0.049; 95%CI: −0.07, −0.03; P<0.01). Investigators also noted that educational attainment was also associated with improvements in HDL cholesterol (β 1.50; 95%CI: 0.34, 2.49; P < 0.01), but was found to worsen BMI (β 0.20; 95%CI: 0.002, 0.40; P = 0.05) and total cholesterol (β 2.73; 95%CI: 0.09, 4.97; p = 0.03).

Hamad suggests that this could be explained by a shift in the availability of healthy food and other factors.

"Overall, people with more education may have reduced heart disease because they have higher incomes, allowing them to afford better food and health care," Hamad said. "Or, it may be that they have more resources and therefore less stress, which has been previously linked with heart disease."

This study, titled “Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis,” is published in PLOS Medicine.