Heart Disease Risk Varies by Education Level

Study Also Shows Risk Is Different in Low-Income and High-Income Countries

Medically Reviewed by Louise Chang, MD on September 07, 2010

Sept. 7, 2010 -- Risk for stroke and heart disease falls as education levels rise in high-income countries, but not in nations where earnings are considerably lower, a new study shows.

The findings are published in the September 2010 issue of Circulation.

The study examined data on 61,332 people from 44 countries who had been diagnosed with heart disease, stroke, or peripheral arterial disease -- or who had cardiovascular risk factors such as smoking or obesity.

"We can't simply take studies that are conducted in high-income countries, particularly as they relate to socioeconomic status and health outcomes, and extrapolate them to low- and middle-income countries," says study researcher Abhinav Goyal, MD, MHS, professor at the Emory School of Medicine in Atlanta. "We need dedicated studies in those settings."

Richer Countries vs. Poorer Countries

The researchers say that in high-income countries, the most educated men smoked less than men with the fewest years of formal education. The prevalence of obesity went down in high-income countries across different education levels but tended to go up in low- to middle- income countries. Although smoking prevalence decreased in men of different education levels from high income countries, it increased in women.

"We can't assume that just because certain groups are more educated than others that they're going to have healthier lifestyles," Goyal says in a news release. "Everyone needs to be educated about the risk of heart disease in particular, and counseled to adopt healthy lifestyles and to quit smoking."

Heart disease and stroke are leading causes of death worldwide, killing an estimated 17.5 million people in 2005. The researchers say that more than 80% of those deaths occurred in low- and middle-income countries.

Heart Disease Around the Globe

"We are facing an increase in the epidemic of cardiovascular disease in countries with developing economies," says study co-researcher Sidney Smith, MD, professor of medicine and director of the Center for Cardiovascular Science and Medicine at the University of North Carolina School of Medicine.

He says the study suggests that strategies need to be developed to deal more effectively with cardiovascular disease in middle- and low-income countries.

The researchers note that the study was funded by drug companies Sanofi-Aventis and Bristol-Myers Squibb and the Tokyo-based Waksman Foundation.