Many studies have documented that education is inversely associated with a wide array of clinical disease outcomes and death, and this relationship between education and cardiovascular disease and coronary heart disease in particular is among the most consistent and pronounced, according to background information in the article. But little is known about the relationship between education and subclinical disease (an illness that stays below the surface of clinical detection).
Lijing L. Yan, Ph.D., M.P.H., of the Feinberg School of Medicine, Northwestern University, Chicago, and Guanghua School of Management, Peking University, Beijing, China, and colleagues analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which included 2,913 participants (44.9 percent black; 53.9 percent women). The participants, who were ages 18-30 at baseline in 1985-1986, were recruited from Chicago, Minneapolis, Birmingham, Ala., and Oakland, Calif. There were 128 study participants with less than a high school diploma; 498 were high school graduates; 902 had some college; 764 were college graduates; and 621 had more than a college education.
At year 15 of the study, the overall prevalence of coronary artery calcium (CAC) among eligible study participants was 9.3 percent.
"For the biracial young adult and early middle-aged cohort (ages 33-45 years) with a wide spectrum of educational levels, we found that educational level was inversely associated with prevalence of CAC in a graded dose-response fashion, with particularly higher prevalence for individuals with less than a high school degree," the authors report.
The prevalence of CAC was four times higher among study participants with less than a high school degree, compared with those who had more than a college education.
"These findings are partially explained by risk factors assessed 15 years before the measurement of CAC and by increase in these risk factors over time," the authors write. The risk factors include blood pressure, cholesterol, waist circumference, smoking, and physical activity. The authors suggest that pathways and mechanisms linking education and subclinical disease remain to be further explored.
"Fundamental changes in preventive measures very early in life are required to address social and economic disparities in health. In addition, integrated prevention and intervention strategies effective for less educated persons are also needed," they conclude.
(JAMA. 2006;295:1793-1800. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was funded by grants from the National Heart, Lung, and Blood Institute, National Institutes of Health.