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Education Level and CAD Risk

Higher education might be associated with lower risk for developing heart disease.

Education level is associated inversely with cardiovascular disease, but the relation might be confounded by cardiac risk factors, access to health care, and treatment adherence. In this longitudinal study of 3043 young adults, researchers evaluated the association between education level and subclinical coronary artery disease (CAD); this focus on subclinical disease reduced the potential for confounding by treatment variables. Traditional risk factors were assessed at baseline (when subjects were 18 to 30), and coronary artery calcium (CAC) was evaluated 15 years later with electron beam computed tomography (EBCT).

Approximately 9% of study participants had CAC (i.e., EBCT calcium score >0). An inverse, dose-response relation was observed between education level and prevalence of CAC. After adjustment for age, sex, and race, individuals without high school diplomas were significantly more likely to have CAC than individuals with college degrees (odds ratio, 4.1). Further adjustment for traditional coronary risk factors (e.g., smoking, cholesterol, blood pressure) attenuated but did not eliminate this association (OR, about 2.5)

Comment: These data are important because they provide information on the association between education level and preclinical CAD. Although this link appears to be mediated partly by traditional risk factors, other mechanisms (e.g., diet, sleep patterns, job stress) might explain some of the observed association.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine April 25, 2006

Citation(s):

Yan LL et al. Education, 15-year risk factor progression, and coronary artery calcium in young adulthood and early middle age: The Coronary Artery Risk Development in Young Adults study. JAMA 2006 Apr 19; 295:1793-800.

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