The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index.

Sci Rep 2017 09 28;7(1):12370. Epub 2017 Sep 28.

CIBER of Cardiovascular Diseases (CIBERCV), ISCIII, Madrid, Spain.

Education and cardiovascular disease (CVD) are inversely associated but the mediating factors have not been totally elucidated. Our aim was to analyze the mediating role of modifiable risk factors. Cohort study using the REGICOR population cohorts. Participants without previous CVD were included (n = 9226). Marginal structural models were used to analyze the association between education and CVD incidence at 6 years of follow-up. Mediation by modifiable risk factors (diabetes, dyslipidemia, hypertension, smoking, body mass index, and physical activity) was assessed using the counterfactual framework. Participants with a university degree had a CVD incidence hazard ratio (HR) of 0.51 (95% confidence interval (CI) = 0.30, 0.85), compared to those with primary or lower education. Only hypertension, BMI, and diabetes mediated the association between education and CVD incidence, accounting for 26% of the association (13.9, 6.9, and 5.2%, respectively). Sensitivity analyses showed that hypertension was the strongest mediator (average causal mediation effect [95% CI] = increase of 2170 days free of CVD events [711, 4520]). The association between education and CVD incidence is partially mediated by hypertension, BMI, and diabetes. Interventions to decrease the prevalence of these risk factors could contribute to diminish the CVD inequalities associated with educational level.

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-017-10775-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620039PMC
September 2017
18 Reads

Publication Analysis

Top Keywords

association education
16
cvd incidence
16
education cvd
12
risk factors
12
bmi diabetes
8
education cardiovascular
8
body mass
8
cvd
8
mediated hypertension
8
hypertension bmi
8
cardiovascular disease
8
modifiable risk
8
education
5
hypertension
5
association
5
incidence
5
confidence interval
4
95% confidence
4
interval ci = 030
4
ci = 030 085
4

References

(Supplied by CrossRef)

EP Havranek et al.
Circulation. 2015

ER Meara et al.
Health Aff (Millwood). 2008

G Rose et al.
Br Heart J. 1981

JR Emberson et al.
Int J Epidemiol. 2004

K Silventoinen et al.
Int J Epidemiol. 2005

M Avendano et al.
Heart. 2006

H Kuper et al.
Stroke. 2007

L Ernsten et al.
Scand J Public Health. 2010

G Veronesi et al.
Heart. 2016

JW Lynch et al.
Am J Epidemiol. 1996

Similar Publications