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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-12

AUTHORS

Irene R. Dégano, Jaume Marrugat, Maria Grau, Betlem Salvador-González, Rafel Ramos, Alberto Zamora, Ruth Martí, Roberto Elosua

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. More... »

PAGES

12370

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/s41598-017-10775-3

DOI

http://dx.doi.org/10.1038/s41598-017-10775-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1091951553

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28959022


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