Abstract 899: The Impact Of Attained Educational Level On Incident Cardiovascular Events Differs Between High-Income Countries and Low-and-Middle-Income Countries
Introduction: A protective association between attained educational level (AEL) and incident cardiovascular disease (CVD) events has been reported in high-income countries (HIC’s). It is unclear whether this association extends to low-and-middle-income countries (LMIC’s), which bear over 80% of the global burden of CVD.
Hypothesis: We hypothesized that the impact of AEL on incident CVD events differs between HIC’s and LMIC’s.
Methods: In the REACH registry, 61,307 subjects with known CVD (coronary, cerebrovascular, or peripheral artery disease) or multiple CVD risk factors were enrolled in 44 countries. AEL was self-reported as the years of education completed: 0 – 8 years; 9 –12 years; trade school; or university. We compared the 2-year age-adjusted incidence of CVD events (composite of CVD death, nonfatal myocardial infarction, or nonfatal stroke) across AEL classes, separately in 4 groups: men in HIC’s, men in LMIC’s, women in HIC’s, and women in LMIC’s.
Results: Higher AEL was associated with a lower prevalence of hypertension and diabetes in all groups (p <0.0001). Higher AEL predicted lower smoking rates in men and in HIC’s (p <0.0001), but in contrast predicted higher smoking rates in women and in LMIC’s (p <0.0001). The protective impact of AEL on incident CVD (Figure⇓) was strongest in men in HIC’s (p <0.0001); more modest in women in HIC’s (p=0.0026) and in men in LMIC’s (p=0.082); and virtually absent in women in LMIC’s (p=0.32).
Conclusion: Studies that report the impact of AEL on CVD outcomes in HIC’s cannot be extrapolated to LMIC’s, especially in women. More research is urgently needed to elucidate the socioeconomic underpinnings of the CVD epidemic in LMIC’s specifically.