Pulse Brain · Growing Health Evidence Index
Tier 3 — Observational / field trialPeer-reviewed

Understanding the consequences of education inequality on cardiovascular disease: mendelian randomisation study

Alice R Carter, Dipender Gill, Neil M Davies, Amy E. Taylor, Taavi Tillmann, Julien Vaucher, Robyn E. Wootton, Marcus R. Munafò, Gibran Hemani, Rainer Malik, Sudha Seshadri, Daniel Woo, Stephen Burgess, George Davey Smith, Michael V. Holmes, Ioanna Tzoulaki, Laura D Howe, Abbas Dehghan

BMJ · 2019

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Summary

This Mendelian randomisation study, drawing on UK Biobank and international genome-wide association study data, found that each additional 3.6 years of education was associated with a substantially lower risk of coronary heart disease, stroke, and related cardiovascular outcomes. The protective effect of education was substantially mediated through three modifiable risk factors: BMI accounted for 15–18% of the risk reduction, systolic blood pressure for 11–21%, and smoking behaviour for 19–34%, with the three factors combined mediating approximately 36–42% of education's protective effect.

UK applicability

These findings are directly applicable to United Kingdom policy and practice, as the study utilised UK Biobank data and was conducted in a predominantly European ancestry population. The results support public health strategies that address educational inequality and modifiable cardiovascular risk factors (weight, blood pressure, smoking) as complementary approaches to reducing cardiovascular disease burden in the UK.

Key measures

Odds ratios for cardiovascular disease outcomes per standard deviation increase in educational attainment (3.6 years); proportions of total effect mediated by BMI, systolic blood pressure, and smoking behaviour (expressed as percentages with 95% confidence intervals)

Outcomes reported

The study quantified the association between educational attainment and cardiovascular disease risk (coronary heart disease, stroke, myocardial infarction), and estimated the proportion of this protective effect mediated through body mass index, systolic blood pressure, and smoking behaviour. Results were obtained using both observational and causal inference (Mendelian randomisation) approaches.

Theme
Nutrition & health
Subject
Dietary patterns & chronic disease
Study type
Research
Study design
Mendelian randomisation study
Source type
Peer-reviewed study
Status
Published
Geography
International
System type
Human clinical
DOI
10.1136/bmj.l1855
Catalogue ID
BFmor3gaas-sjh0jw

Topic tags

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