Low education status is associated with greater extent of silent atherosclerosis: preliminary data from the REACT study
J B Kunkel, R Hasselbalch, M V Kragh, N Eldrup, K Iversen, V Mass Ruiz, C N Perez Garcia, A Devesa Arbiol, V Fuster, I Garcia Lunar, B Ibanez, H BundgaardAbstract
Background
Social determinants of health are established risk factors for cardiovascular events, yet their association with silent atherosclerosis in a universal healthcare settings remains poorly characterised.
Purpose
The aim was to determine the prevalence of silent atherosclerosis across educational strata and geographic areas in a large Danish population-based cohort.
Methods
In a cross-sectional population based study, we included 7,131 Danish participants from the REACT study (52% female, mean age 45±13 years). Atherosclerotic plaque was defined by the Mannheim criteria using vascular ultrasound of bilateral carotid and femoral arteries. Educational attainment was categorised as primary school, vocational, upper secondary, bachelor's, or master's/PhD. Logistic regression estimated odds ratios adjusted for age, sex, and examination site. Geographic variation was mapped at postal-code level using inverse distance weighting interpolation.
Preliminary Results
Crude plaque prevalence ranged from 42.7% (primary school) to 29.4% (master's/PhD). After adjustment for age, sex, and site, lower educational attainment remained independently associated with any plaque (primary school vs master's/PhD: OR 1.29, 95% CI 1.01–1.65; vocational: OR 1.21, 1.03–1.43; P-for-trend=0.004). The education gradient was more pronounced for multi-territory disease (primary school: OR 1.62, 1.19–2.20; P-for-trend <0.001) (Figure 1). Spatial mapping revealed geographic clustering of high-prevalence areas, with significant inter-site variation ('site H' vs 'site R': OR 1.35, 1.14–1.59, P<0.001) (Figure 2).
Conclusion
In this large Danish population-based cohort, lower educational attainment was independently associated with higher prevalence of silent atherosclerosis, particularly multi-territory plaque burden. Geographic clustering suggests that area-level socioeconomic factors may influence subclinical cardiovascular disease despite universal healthcare access, and may inform targeted prevention strategies.Figure 1Figure 2