Higher educational attainment is associated with improved cardiovascular health in women and men in a general european population

Background

Cardiovascular health (CVH), as defined by the American Heart Association’s Life’s Essential 8 (LE8), is inversely associated with cardiovascular disease and mortality. Although socioeconomic status (SES) is a well-established determinant of cardiovascular outcomes, comprehensive assessments of the association between SES and LE8 remain limited in general European populations.

Purpose

This study investigates the association between educational attainment, as a key SES indicator, and overall LE8 score, focusing on sex-specific differences, in a large population-based sample. We hypothised that higher educational attainment is associated with better cardiovascular health, with potential sex-specific differences.

Methods

We performed a cross-sectional analysis of 11 113 eligible adults aged ≥40 years from a population-based health survey (2015–2016). We calculated LE8 scores (range 0–100) according to American Heart Association criteria, using self-reported questionnaires, clinical measurements, and blood samples. We categorised educational attainment into four levels: ≤10 years of schooling, high school diploma, <4 years college/university, and ≥4 years college/university. We used age-adjusted linear regression models to assess the association between education and LE8 score, separately for women and men.

Results

In age-adjusted analyses, higher educational level was associated with progressively higher LE8 scores in both sexes. Compared with the lowest group (≤10 years of education), women with ≥4 years of college/university had a 9.3-point higher LE8 score (95% confidence interval 8.4, 10.2), while the corresponding difference in men was 8.3 points (7.4, 9.3). Per educational increment, LE8 increased by 3.2 points (2.9, 3.5) in women and 2.8 points (2.5, 3.1) in men. These regression coefficients were not significantly different between women and men (p for interaction=0.088).

Educational gradients were observed across individual LE8 components. The strongest gradients were seen for nicotine exposure (regression coefficients per educational increment, 6.5 in women and 6.1 in men), physical activity (3.9 and 4.7), BMI (3.6 and 3.0) and blood pressure (3.4 and 1.7), respectively. Sex differences were statistically significant for blood pressure and blood lipids (p<0.05), with stronger associations among women. Associations with blood glucose, nutrition and sleep were modest.

Conclusion

Higher educational attainment was associated with more favourable cardiovascular health as measured by LE8 in this European population sample. Educational inequalities were observed across several cardiovascular health metrics and were partly more pronounced in women. These findings underscore socioeconomic gradients as an important determinant of cardiovascular health at the population level.Fig1_Edu_LE8_ForestPlot