Education Impacts Heart Health

Summary
Studies have shown that lower educational status is often associated with a higher risk of heart disease. This study attempted to see if low education was associated with higher rates of hypertension or high blood pressure. The researchers attempted to explore this link since blood pressure is a risk factor for heart disease.  The results showed that blood pressure was significantly higher in persons who had less than 12 years education, when compared with those who had more than 17 years of education. This association was better established in women.

Introduction
There is evidence that factors like socioeconomic status, occupation, income and educational status affect the risk of heart disease, especially in developed countries. There is, however, scant evidence on whether educational status is linked to high blood pressure –- a marker of heart disease risk. Long term studies following an individual over life, to assess the effect of low educational status on blood pressure, have not been conducted. Studies to review the association between low education and related heart disease outcomes have also not been undertaken. This study aimed at following individuals over a period of 30 years. Over the study period, researchers evaluated the effect of low educational status on blood pressure and heart disease related outcomes. The study also attempted to look into other related factors like gender, obesity, smoking etc.

Methodology
* A total of 3,890 subjects were included in the research exercise, which was carried out under the “Framingham Offspring Study.”
* The average age of the participants was around 36 years. There were 52% females in the study group. All the participants were followed up for 30 years, from 1971 to 2001. The educational status of all the participants was recorded.
* At every visit, medical history, physical examinations as well as blood pressures at different time points, consumption of blood pressure lowering medication, smoking status, alcohol consumption and other factors were recorded for analysis. Both systolic and diastolic blood pressures were recorded.

Results
* The systolic blood pressure of the participants with less than 12 years of education was significantly higher than those with more than 17 years of education over the study period of 30 years.
* In women, the systolic blood pressure was, on an average, 3.26 mm of Hg higher in the low educated group. Among men, it was 2.26 mm of Hg higher in the lower-educated group. At follow up after 30 years, men with low education status had 1.20 mm of Hg higher systolic blood pressure, as compared to those with more than 17 years education.
* The associations were clearer in women participants than in men.

Next steps/Shortcomings
The authors agree that since the study was planned a few decades back, the original study population comprised of mainly Caucasians. This study, therefore, did not discover if similar differences could be seen in other races and ethnic groups. Smoking, alcohol consumption and details of any medication being used to treat blood pressure were reported by the participants; this could have been erroneous. Further studies could include other risk factors such as childhood obesity and inherited high blood pressure, along with education status.

Conclusion
This study found that a lower education status is often associated with higher risk of blood pressure, especially in women. The authors write that a lower educational status may be associated with getting a job that entails high level of stress and also a poorer socioeconomic status. This may be especially true for females who may also be coping with other factors associated with low education like single parenting and depressive illness. This level of strain may be contributing to high blood pressure. Also, people from the lower socioeconomic status often indulge in more unhealthy diet, with less fruits and vegetables and more salty and fried foods. This could contribute to the high blood pressure. Overall, risk factors for heart disease and high blood pressure in the socioeconomically and educationally backward are high.

For More Information:
Associations of Education with 30 Year Life Course Blood Pressure Trajectories: Framingham Offspring Study
Publication Journal: BMC Public Health, February 2011
By Eric B Loucks, PhD; Michal Abrahamowicz; Brown University, Providence, Rhode Island, USA and McGill University, Montreal, Quebec, Canada

*FYI Living Lab Reports Are Summaries of the Original Research.