Heart disease is a leading cause of mortality in the US, and clinicians are increasingly interested in addressing its social and economic determinants. Education is highly correlated with heart disease, but this may be because education and heart disease have common causes such as parental socioeconomic status and genetic factors. Even if there is a causal relationship, the mechanisms by which education influences heart disease are unclear. As a result, there is ongoing debate as to whether education should be included in cardiovascular disease prediction algorithms, and it is also unclear whether interventions targeting education might affect cardiovascular disease. To address this gap in knowledge, Hamad and colleagues leveraged a natural experiment--variation in US education policies that determine schooling duration--to examine possible effects of education on heart disease and its risk factors.
The authors linked census data on educational attainment during childhood (covering approximately 5.4 million individuals) with health outcomes in adulthood (covering 30,853 and 44,732 participants in two surveys). Increased education was consistently associated with a reduction in heart disease and improvements in several cardiovascular risk factors, including smoking, high-density lipoprotein, and depression. However, increased education was also associated with higher body-mass index and total cholesterol. Taken together, the findings contribute new knowledge on potential pathways through which education may influence cardiovascular disease. According to the authors, the findings strengthen the argument for intervening on education to reduce disparities in cardiovascular disease, and support the inclusion of educational attainment in prediction algorithms and primary prevention guidelines for cardiovascular disease.