Journal
SCIENTIFIC REPORTS
Volume 7, Issue -, Pages -Publisher
NATURE PORTFOLIO
DOI: 10.1038/s41598-017-10775-3
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Funding
- RECERCAIXA Program, Obra Social La Caixa [RE087465]
- Spanish Ministry of Economy through the Carlos III Health Institute (Red de Investigacion Cardiovascular Programa) [HERACLES RD12/0042, Red RedIAPP RD06/0018, CIBERCV CB16/11/00229]
- European Regional Development Funds (ERDF-FEDER) Health Research Fund [FIS-90/0672, FIS-93/0568, FIS 94/0539, FIS96/0026-01, FIS99/0655, FIS99/0013-01, FIS 99/9342, FIS 2003/HERMES, PI20471, FIS14/00449, CP12/03287]
- Government of Catalunya through Agencia de Gestio Ajuts Universitaris de Recerca [2014 SGR 240]
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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.
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