Educational Attainment and Lifetime Risk of Cardiovascular Disease

Abstract

ImportanceEducation is a social determinant of health. Quantifying its association with lifetime cardiovascular disease (CVD) risk has public health importance.ObjectiveTo calculate lifetime risk estimates of incident CVD and CVD subtypes and estimate years lived with and without CVD by education.Design, Setting, and ParticipantsIncluded community-based cohort studies with adjudicated cardiovascular events used pooled individual-level data from 1985 to 2015 of 6 prospective cohort studies. The study team assessed the association between education and lifetime CVD risk with modified Kaplan-Meier and Cox models accounting for competing risk of noncardiovascular death. The study team estimated years lived with and without CVD by education with the Irwin restricted mean and the utility of adding educational attainment to CVD risk assessment. Participants (baseline 40 to 59 years old and 60 to 79 years old) were without CVD at baseline and had complete education, cardiovascular risk factors, and prospective CVD outcomes data. Data were analyzed from January 2022 to September 2022.ExposuresEducational attainment (less than high school, high school completion, some college, or college graduate).Main outcome and measuresCardiovascular events (fatal and nonfatal coronary heart disease, heart failure, and stroke; CVD-related deaths; and total CVD encompassing any of these events).ResultsThere were 40 998 participants (23 305 female [56.2%]) with a mean (SD) age of 58.1 (9.7) years for males and 58.3 (9.9) years for females. Compared with college graduates, those with less than high school or high school completion had higher lifetime CVD risks. Among middle-aged men, the competing hazard ratios (HRs) for a CVD event were 1.58 (95% CI, 1.38-1.80), 1.30 (95% CI, 1.10-1.46), and 1.16 (95% CI, 1.00-1.34) in those with less than high school, high school, and some college, respectively, compared with those with college completion. Among women, these competing HRs were 1.70 (95% CI, 1.49-1.95), 1.19 (95% CI, 1.05-1.35), and 0.98 (95% CI, 0.83-1.15). Individuals with higher education had longer duration of life prior to incident CVD. Education provided limited contribution toward enhancing CVD risk prediction.Conclusions and relevanceLower education was associated with lifetime CVD risk across adulthood; higher education translated to healthy longevity. Educational policy initiatives may associate with long-term health benefits.

Educational Attainment and Cardiovascular Risk—A Missed Opportunity?—Reply

“…Racial differences in the effect of educational attainment in relation to cardiovascular risk in the US are consequently expected . As noted in our article, we appreciate that education is both directly related to health and a proxy for multiple social and structural factors extending from early life to adolescence and beyond. Hence, we would argue that educational attainment in individuals of Black race is necessary to foster health outcomes but insufficient to achieve equitable outcomes comparable with individuals of White race, as demonstrated by our analysis.…”

“…In Reply We appreciate the thoughtful attention provided by Veronesi and colleagues to our article assessing the lifetime risk between educational attainment and cardiovascular disease . We would foremost urge caution when considering standardization of race-specific percentiles of education as suggested by our colleagues here.…”

Trend and Factors Associated with Cardiovascular Risk in Peru: An Analysis of the National Demographic and Family Health Survey, 2014-2022

“…Additional studies propose that the level of education attained notably impacts the likelihood of developing heart conditions, emphasizing how acquiring knowledge represents a crucial societal influencer on individual well-being, as previously reported (24) . Furthermore, research exploring the connection between educational attainment and cardiovascular disease risk across the lifespan has evaluated education as an essential determinant for anticipating cardiovascular disease hazards based on existing evidence (25) . Studies have additionally noted how the degree of formal education that one attains can impact the projected outcomes regarding cardiovascular illnesses, such as stroke, owing to dissimilarities in the regularity of conventional risk elements between groups with divergent levels of academic accomplishment (26) .…”