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

Scientific reports, 2017-09, Vol.7 (1), p.12370-8, Article 12370 [Peer Reviewed Journal]

2017. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;The Author(s) 2017 ;ISSN: 2045-2322 ;EISSN: 2045-2322 ;DOI: 10.1038/s41598-017-10775-3 ;PMID: 28959022

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Title:
The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index
Author: Dégano, Irene R ; Marrugat, Jaume ; Grau, Maria ; Salvador-González, Betlem ; Ramos, Rafel ; Zamora, Alberto ; Martí, Ruth ; Elosua, Roberto
Subjects: Adult ; Aged ; Body Mass Index ; Cardiovascular disease ; Cardiovascular Diseases - epidemiology ; Cohort Studies ; Comorbidity ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - epidemiology ; Dyslipidemia ; Education ; Educational Status ; Female ; Health risk assessment ; Humans ; Hypertension ; Hypertension - epidemiology ; Incidence ; Male ; Middle Aged ; Physical activity ; Population studies ; Prevalence ; Proportional Hazards Models ; Risk Assessment - methods ; Risk Assessment - statistics & numerical data ; Risk factors ; Sensitivity analysis ; Smoking ; Spain - epidemiology
Is Part Of: Scientific reports, 2017-09, Vol.7 (1), p.12370-8, Article 12370
Description: 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.
Publisher: England: Nature Publishing Group
Language: English
Identifier: ISSN: 2045-2322
EISSN: 2045-2322
DOI: 10.1038/s41598-017-10775-3
PMID: 28959022
Source: MEDLINE
PubMed Central
ProQuest Central
DOAJ Directory of Open Access Journals

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

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