Education and coronary heart disease: a Mendelian randomization study

Abstract

ObjectivesTo determine whether educational attainment is a causal risk factor in the development of coronary heart disease.DesignMendelian randomization study, where genetic data are used as proxies for education, in order to minimize confounding. A two-sample design was applied, where summary level genetic data was analysed from two publically available consortia.SettingIn the main analysis, we analysed genetic data from two large consortia (CARDIoGRAM and SSGAC), comprising of 112 cohorts from predominantly high-income countries. In addition, we also analysed genetic data from 7 additional large consortia, in order to identify putative causal mediators.ParticipantsThe main analysis was of 589 377 men and women, predominantly of European origin.ExposureA one standard deviation increase in the genetic predisposition towards higher education (i.e. 3.6 years of additional schooling). This was measured by 162 genetic variants that have been previously associated with education.Main outcomeCombined fatal and nonfatal coronary heart disease (63 746 events).Results3.6 years of additional education lowered the risk of coronary heart disease by a third (odds ratio = 0.67, 95% confidence interval [CI], 0.59 to 0.77, p=0.01). Equivalent increases in education were also causally associated with reductions in smoking, BMI and improvements in blood lipid profiles.ConclusionsMore time spent in education is causally associated with a large reduction in the risk of coronary heart disease. This may be partly explained by changes to smoking, BMI and a blood lipids. These findings offer support for policy interventions that increase education, in order to also reduce the burden of cardiovascular disease.

Cognitive ability and physical health: a Mendelian randomization study

“…The current study used the same data for educational attainment on a subset of individuals (N = 293,723), and 111,712 individuals with BMI data; however, coronary artery disease was based on self-report diagnosis in UK Biobank, which included 110,072 (5288 cases) individuals. The summary level data for coronary artery disease in the Tillmann, et al 35 report included both European and East-Asian individuals, whereas the current study only includes individuals of White British ancestry. They 35 excluded overlapping cohorts between educational attainment and coronary artery disease data; however, it is unclear if overlapping cohorts were excluded for BMI.…”

“…The summary level data for coronary artery disease in the Tillmann, et al 35 report included both European and East-Asian individuals, whereas the current study only includes individuals of White British ancestry. They 35 excluded overlapping cohorts between educational attainment and coronary artery disease data; however, it is unclear if overlapping cohorts were excluded for BMI.…”

“…The current study did include individuals who reported having a college degree, however used a categorical measure of four categories, whereas Tyrrell, et al 13 used a continuous measure of time spent in full time education. In a non-peer-reviewed (at the time of writing) study, Tillmann, et al 35 did report a causal association from educational attainment to coronary artery disease and BMI using a two-sample MR approach based on two independent consortia 35 . They used data from two independent GWAS consortia, including 349,306 individuals for educational attainment, 194,427 (63,746 cases) individuals for coronary artery disease, and 339,224 individuals for BMI.…”

Automating Mendelian randomization through machine learning to construct a putative causal map of the human phenome

“…Several of these putative relationships appear to be plausible, for example the influence of years of schooling on lower risk of Alzheimer's disease, which has recently been reported (43). There is also a protective effect of more years of schooling on lower risk of myocardial infarction, which has been supported by detailed follow up analyses (44).…”

Assessment of level of Knowledge and Practice of Patients Undergoing Cardiac Catheterization

“…Tillmann 2018).Patient educational process relevant to the patient's level of understanding, comprehensive, delivered at the appropriate time, as well as designed to understand can be one of the prerequisites for the patient to get some inspiration to change attitudes, increase knowledge, practice, motivation and awareness of the importance of co-responsibility to Port Said Scientific Journal of NursingVol.7, No. 4, December 2020 167 make decisions about medical treatment, the patient's behavior or change of habits (Bēta, 2014 &) Koren & Sharaf, 2016)…”