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Education less preventive of CVD in low- to mid-income countries vs. high-income countries
Goyal A. Circulation. 2010;doi:10.1161/circulationaha.109.919274.
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Participants’ educational level was not preventive of CVD in low- and middle-income countries. However, in high-income countries, researchers reported an inverse association with several key CV risk factors.
“Atherothrombotic diseases — coronary heart disease, cerebrovascular disease and peripheral arterial disease — are the leading cause of death worldwide,” the REACH investigators wrote in their study. “Attained educational level is a socioeconomic indicator that strongly predicts CV outcomes.”
The Reduction of Atherothrombosis for Continued Health (REACH) Registry was a prospective study of participants (n=67,888) with either established atherothrombotic disease or multiple atherothrombotic risk factors enrolled from physician practices (n=5,587) located in 44 countries. Attained educational level was self-reported at baseline in 61,332 participants. Researchers stratified outcomes, including baseline prevalence of atherothrombotic risk factors and the rate of incident CV events, by sex and world region through 23 months across AEL groups.
According to study data, attained educational level was directly associated with hypercholesterolemia but inversely related to age and diabetes mellitus in all participants. Researchers also reported that attained educational level was inversely associated with risk factors such as obesity, hypertension, smoking and baseline burden of vascular disease in high-income countries, but not in low- and middle-income countries. The protective effect of greater attained educational levelon incident CV events from high-income countries was most pronounced in men (P<.0001) than in women (P=.0026), whereas the association was not statistically significant in men or women from low- and middle-income countries.
“These results indicate that studies that report a protective association between attained educational level and CV outcomes in [high-income countries] do not extrapolate to [low- and middle-income countries], especially in women,” the researchers concluded. “Further studies dedicated to [low- and middle-income countries] settings are essential to investigate the association between socioeconomic indicators and CV outcomes in these regions.”
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