UNIVERSITY OF PITTSBURGH
Formal education typically occurs early in life, yet its ramifications for cardiovascular health can last for decades, according to a study by researchers at the University of Pittsburgh School of Medicine and the Feinberg School of Medicine at Northwestern University and published in JAMA Cardiology .
Key points What is the association between educational level and lifetime risk of cardiovascular disease (CVD) in middle and late adulthood? Findings In this study that brought together 6 community cohorts, educational level was significantly associated with cardiovascular diseases. Lower educational attainment was associated with shorter longevity and a higher proportion of life lived with CVD, and those without secondary education were most likely to have a competing risk for CVD. Meaning The results of this study provide a critical perspective on CVD and its association with educational level; Educational opportunities in the early years of life can have lasting effects in middle and old age. |
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To quantify the extent to which education influences the lifetime risk of cardiovascular diseases, such as heart attack or stroke, a team led by Dr. Jared W. Magnani, a UPMC cardiologist and associate professor of medicine at Pitt, examined six data sets following more than 40,000 men and women who identified as white or black. The data spanned three decades, from 1985 to 2015. The study took into account competing risks, that is, death from non-cardiovascular causes.
The team’s analysis showed that, on average, cardiovascular diseases appear later in life in people with progressively higher levels of education. Study participants with less than a high school education were 1.4 to 1.7 times more likely to experience a cardiovascular event than college graduates.
The article discusses potential mechanisms for these findings. Educational level is a known social determinant of health. In the United States, it is closely related to vocational opportunities and, in turn, access to general and specialized care treatments, material advantages, and environmental and psychological exposures. Education also influences health literacy and health behaviors that can reduce cardiovascular risk.
The team also compared the average age at which cardiovascular events occurred with the number of years people lived after them, and found that education is protective not only in terms of whether people have a cardiovascular event, but also when. . “Education is associated with a longer duration of health, protecting people from cardiovascular events until later in life,” Magnani said.
The study showed that the association between education and the risk of cardiovascular events differed by race. Higher educational attainment was more protective of cardiovascular health for white people in the study than for black people. In fact, black participants with higher education were still at elevated risk compared to their white counterparts.
The reasons for this disparity are “both simple and complex,” Magnani said, pointing to the systemic and structural racism that creates segregation in housing, opportunities, and resources both tangible and social. “The bottom line is that education is necessary, but not sufficient , to moderate the risk of profound generational obstacles secondary to structural racism.”
Magnani highlighted that educational level deserves more attention in the design of clinical trial studies. "Social determinants of health do not change the outcomes our patients experience: they are drivers of those outcomes." And yet, education and other social determinants of health are often missing from research, she said.
This study was funded in part by the National Heart, Lung, and Blood Institute (R21 HL085375). Dr. Magnani is supported by the National Heart, Lung, and Blood Institute (K24HL160527).
