risk factors for cardiovascular disease

There is evidence indicating that socioeconomic status is associated with a lifetime risk of cardiovascular diseases (CVD) such as coronary heart disease, heart failure, and stroke. The outcome of a recent study suggests that the level of education and nature of occupation may influence their risk of CVD.


Cardiovascular diseases are the leading cause of death around the world. Being a multifactorial condition, its management requires a complete change in lifestyle. It has been observed that better education is linked to improved health behaviours, occupations and working conditions. Apart from the physiological factors that contribute to the disease, is it possible that socioeconomic factors also compound the severity of the CVD?

Researchers at the Division of Epidemiology and Community Health at the University of Minnesota attempted to answer this question. They investigated how educational inequality affects CVD by estimating the lifetime risks of CVD in a large biracial cohort. They also assessed other important socioeconomic factors such as income, occupation, and parental education that are related to the link between educational attainment and the lifetime risk of CVD.

In the study published in JAMA Internal Medicine(1), epidemiologists assessed the data from an ongoing population based prospective study called The Atherosclerosis Risk in Communities (ARIC). In total, 15,792 individuals aged 45 to 65 years from four US communities were recruited and examined. The cohort consisted mostly of white or African American men and women. The participants were re-examined in 1996 through 1998 with a 4.80% visit return. The main risk factor measurements were in the form of self-reported educational attainment, and categorised into 6 levels: (1) grade school, (2) high school without graduation, (3) high school with graduation, (4) vocational school, (5) college with or without graduation, and (6) graduate or professional school. To further strengthen the study in terms of the socioeconomic landscape, the income of the families and nature of their occupation were also bracketed. CVD events were defined as heart disease, heart failure, and stroke. Participants were contacted annually by telephone to record all hospitalisations and deaths related to the aforementioned CVD events.

The broad outcome of the study revealed that individuals with higher education attainment were likely to have better socioeconomic status and live a healthier lifestyle with fewer incidents of health impairments. Out of the 13,948 participants (6108 men and 7840 women) who provided the information, 4,512 incidents of CVD events and 2,401 incidents of death were reported. The overall lifetime risks of CVD were 48.6% for white men, 34.3% for white women, 52% for African American men, and 45% for African American women. The educational attainment showed an inverse dose-response relation with the lifetime risk of CVD. There was a 20% lower attributable risk in the highest educational group with the percentage of risk placed at 60% (men) and 50% (women) in the lowest education bracket, compared to40% (men) and 30% (women) with the higher education level. A noteworthy finding was that this inverse relationship was also applicable to the younger population of middle age.

The main caveat of the study was the presence of confounding factors and other variables such as other risk factors for cardiovascular disease, lack of information on age at education completion, and the global events like World Wars and the Great Depression that could have influenced the CVD outcomes. However, even with its limitations, the study highlights the importance of education and its direct correlation with the health awareness. The findings emphasize the need to alleviate the CVD burden by higher education attainment. This is a definitive step forward in population healthcare management and critical care.

Written by Akshita Wason, B. Tech, PhD

  1. Kubota, Yasuhiko, et al. “Association of Educational Attainment With Lifetime Risk of Cardiovascular Disease: The Atherosclerosis Risk in Communities Study.” JAMA Internal Medicine(2017).
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