Gender differences in the association between education and the incidence of cardiovascular events in Northern Italy.
BACKGROUND
The educational differences in the incidence of major cardiovascular events are under-studied in Southern Europe and among women.


METHODS
The study sample includes n = 5084 participants to 4 population-based Northern Italian cohorts, aged 35-74 at baseline and with no previous cardiovascular events. The follow-up to ascertain the first onset of coronary heart disease (CHD) or ischaemic stroke ended in 2002. At baseline, major cardiovascular risk factors were investigated adopting the standardized MONICA procedures. Two educational classes were obtained from years of schooling. Age- and risk factors-adjusted hazard ratios of first CHD or ischaemic stroke were estimated through sex-specific separate Cox models (high education as reference).


RESULTS
Median follow-up time was 12 years. Event rates were 6.38 (CHD) and 2.12 (ischaemic stroke) per 1000 person-years in men; and 1.59 and 0.94 in women. In men, low education was associated with higher mean Body Mass Index and prevalence of diabetes and cigarette smokers; but also with higher HDL cholesterol and a more favourable alcohol intake pattern. Less-educated women had higher mean systolic blood pressure, Body Mass Index and HDL cholesterol and were more likely to have diabetes. Men and women in the low educational class had a 2-fold increase in ischaemic stroke and CHD incidence, respectively, after controlling for major risk factors. Education was not associated with CHD incidence in men. Higher ischaemic stroke rates were observed among more educated women.


CONCLUSIONS
In this northern Italian population, the association between education and cardiovascular risk seems to vary by gender.
Dipartimento di Medicina Sperimentale, Università degli Studi dell'Insubria, Varese, Italy.
Giovanni
G
Veronesi
Marco M
MM
Ferrario
Lloyd E
LE
Chambless
Roberto
R
Sega
Giuseppe
G
Mancia
Giovanni
G
Corrao
Carla
C
Fornari
Giancarlo
G
Cesana
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D016016:Proportional Hazards Models; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*; D011795:Surveys and Questionnaires