title: Can cardiovascular risk factors explain the association between education and cardiovascular disease in young women?
abstract: We sought to explain the observed variation in the relationship between education and cardiovascular disease (CVD) among young women in countries at different stages of economic development. Data comprised 2,478 cases of acute myocardial infarction (AMI) or stroke and 6,819 age-matched controls from Africa, Asia, Eastern Europe, and Latin America. The risks of AMI associated with lower education observed in Eastern Europe and higher education in non-European countries were reduced by 92% in Eastern Europe and totally abolished in non-European countries by adjustment for standard cardiovascular risk factors. The inverse associations between education and stroke risk in the three non-African regions were attenuated by 22, 47, and 60% after adjustment. In Africa, the slight inconsistent trend towards lower stroke risk in less well educated women was unaffected by adjustment. These data suggest that standard risk factors explain a substantial proportion if not all of the difference in AMI risk associated with education but a lesser proportion of educationally linked stroke risk.
authors.affiliation: Cardiovascular Studies Unit, Department of Clinical Pharmacology, Imperial College of Science, Technology and Medicine, St. Mary's Campus, London W2 1PG, UK.
authors.forename: Choon-Lan
authors.initials: CL
authors.lastname: Chang
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shipley
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
authors.forename: Neil R
authors.initials: NR
authors.lastname: Poulter
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D016022:Case-Control Studies; D016001:Confidence Intervals; D003466:Cultural Characteristics; D004522:Educational Status; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000523:psychology; D015588:Observer Variation; D016017:Odds Ratio; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology* / Q000523:psychology; D016387:Women's Health; D014944:World Health Organization