Understanding the consequences of education inequality on cardiovascular disease: mendelian randomisation study
Year: 2019
Type: article
Study design: Observational Study
Abstract: Objectives To investigate the role of body mass index (BMI), systolic blood pressure, and smoking behaviour in explaining the effect of education on the risk of cardiovascular disease outcomes. Design Mendelian randomisation study. Setting UK Biobank and international genome-wide association study data. Participants Predominantly participants of European ancestry. Exposure Educational attainment, BMI, systolic blood pressure, and smoking behaviour in observational analysis, and randomly allocated genetic variants to instrument these traits in mendelian randomisation. Main outcomes measure The risk of coronary heart disease, stroke, myocardial infarction, and cardiovascular disease (all subtypes; all measured in odds ratio), and the degree to which this is mediated through BMI, systolic blood pressure, and smoking behaviour respectively. Results Each additional standard deviation of education (3.6 years) was associated with a 13% lower risk of coronary heart disease (odds ratio 0.86, 95% confidence interval 0.84 to 0.89) in observational analysis and a 37% lower risk (0.63, 0.60 to 0.67) in mendelian randomisation analysis. As a proportion of the total risk reduction, BMI was estimated to mediate 15% (95% confidence interval 13% to 17%) and 18% (14% to 23%) in the observational and mendelian randomisation estimates, respectively. Corresponding estimates were 11% (9% to 13%) and 21% (15% to 27%) for systolic blood pressure and 19% (15% to 22%) and 34% (17% to 50%) for smoking behaviour. All three risk factors combined were estimated to mediate 42% (36% to 48%) and 36% (5% to 68%) of the effect of education on coronary heart disease in observational and mendelian randomisation analyses, respectively. Similar results were obtained when investigating the risk of stroke, myocardial infarction, and cardiovascular disease. Conclusions BMI, systolic blood pressure, and smoking behaviour mediate a substantial proportion of the protective effect of education on the risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of cardiovascular disease attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.
Source: BMJ
DOI: 10.1136/bmj.l1855
Institutions: University of Bristol, MRC Integrative Epidemiology Unit, Imperial College London, University Hospitals Bristol NHS Foundation Trust, National Institute for Health and Care Research, University College London, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Institut für Schlaganfall- und Demenzforschung, Ludwig-Maximilians-Universität München, Boston University, The University of Texas at San Antonio Health Science Center, Framingham Heart Study, University of Cincinnati, University of Cambridge, MRC Biostatistics Unit, University of Oxford, NIHR Oxford Biomedical Research Centre, MRC Population Health Research Unit, University of Ioannina
Language: English
Subfield: Genetics
Domain: Life Sciences
Open Access status: hybrid
Funders: Wellcome Trust, National Institute for Health and Care Research, British Heart Foundation, Imperial College London, University of Bristol, National Institutes of Health, Medical Research Council, Economic and Social Research Council, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Neurological Disorders and Stroke
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OpenAlex ID: W2946081713