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Sci Rep. 2017 Sep 28;7(1):12370. doi: 10.1038/s41598-017-10775-3.

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

Author information

1
CIBER of Cardiovascular Diseases (CIBERCV), ISCIII, Madrid, Spain. iroman@imim.es.
2
REGICOR Study Group. Cardiovascular Epidemiology and Genetics Group. Epidemiology and Public Health Program. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. iroman@imim.es.
3
CIBER of Cardiovascular Diseases (CIBERCV), ISCIII, Madrid, Spain.
4
REGICOR Study Group. Cardiovascular Epidemiology and Genetics Group. Epidemiology and Public Health Program. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
5
School of Pharmacy, University of Barcelona, Barcelona, Spain.
6
ABS Florida Sud and Cardiovascular Research Group in Primary Care (MACAP Costa Ponent), Primary Care Research Institute Jordi Gol, Catalan Institute of Health, l'Hospitalet de Llobregat, Barcelona, Spain.
7
Vascular Health Research Group (ISV-Girona). Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
8
Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.
9
Institut Català de la Salut, Àmbit d'atenció Primaria, Girona, Spain.
10
Lipid and Atherosclerosis Unit and Department of Internal Medicine, Hospital de Blanes, Girona, Spain.
11
Institut d'Investigació Biomèdica de Girona (IDIBGI), Hospital Universitari Dr. Josep Trueta, Girona, Spain.
12
CIBER of Cardiovascular Diseases (CIBERCV), ISCIII, Madrid, Spain. relosua@imim.es.
13
REGICOR Study Group. Cardiovascular Epidemiology and Genetics Group. Epidemiology and Public Health Program. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. relosua@imim.es.

Abstract

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.

PMID:
28959022
PMCID:
PMC5620039
DOI:
10.1038/s41598-017-10775-3
[Indexed for MEDLINE]
Free PMC Article

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