Association between education and the risk of incident coronary heart disease among middle-aged and older Chinese: the Dongfeng-Tongji Cohort

Abstract

Educational achievement was related to cardiovascular disease in some western populations, but prospective evidence on the relationship between education and the risk of incident coronary heart disease (CHD) in Asians is scarce. We aimed to explore this association and the potential modifying effect of major CHD risk factors related to education in middle-aged and older Chinese adults. We included 18,551 participants with mean age 62.8 years at baseline between September 2008 and June 2010, and followed the population until October 2013. Cox proportional hazard models and log-binomial regression models were used for multivariate analyses. Compared with participants with low education, the adjusted hazard ratio (HR) and 95% confidence interval (95% CI) for incident CHD in those with high education was 0.89 (95% CI: 0.80, 0.98). In addition, such inverse association between education and the risk of incident CHD was more evident among individuals who were more than 60 years, physically active, overweight, and hypertension. Besides, decreases in the relative index of inequality with high education versus low education were from 0.83 to 0.76 for hypertension, from 0.85 to 0.82 for diabetes. In conclusion, education was inversely associated with the risk of incident CHD among middle-aged and older Chinese adults.

Figure 1

Subgroup analysis of association between education and the risk of incident CHD according to potential risk factors. All covariates were age, smoking, drinking, physical activity, marital status, stress, fruit intake, vegetable intake, BMI, waist circumference, hypertension, hyperlipidemia, diabetes, and family history of CHD. Each group adjusted for the other covariates except itself. The reference group was low education. Horizontal lines represent 95% confidence intervals.