Cargando…
The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index
Education and cardiovascular disease (CVD) are inversely associated but the mediating factors have not been totally elucidated. Our aim was to analyze the mediating role of modifiable risk factors. Cohort study using the REGICOR population cohorts. Participants without previous CVD were included (n ...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620039/ https://www.ncbi.nlm.nih.gov/pubmed/28959022 http://dx.doi.org/10.1038/s41598-017-10775-3 |
_version_ | 1783267504170205184 |
---|---|
author | Dégano, Irene R. Marrugat, Jaume Grau, Maria Salvador-González, Betlem Ramos, Rafel Zamora, Alberto Martí, Ruth Elosua, Roberto |
author_facet | Dégano, Irene R. Marrugat, Jaume Grau, Maria Salvador-González, Betlem Ramos, Rafel Zamora, Alberto Martí, Ruth Elosua, Roberto |
author_sort | Dégano, Irene R. |
collection | PubMed |
description | Education and cardiovascular disease (CVD) are inversely associated but the mediating factors have not been totally elucidated. Our aim was to analyze the mediating role of modifiable risk factors. Cohort study using the REGICOR population cohorts. Participants without previous CVD were included (n = 9226). Marginal structural models were used to analyze the association between education and CVD incidence at 6 years of follow-up. Mediation by modifiable risk factors (diabetes, dyslipidemia, hypertension, smoking, body mass index, and physical activity) was assessed using the counterfactual framework. Participants with a university degree had a CVD incidence hazard ratio (HR) of 0.51 (95% confidence interval (CI) = 0.30, 0.85), compared to those with primary or lower education. Only hypertension, BMI, and diabetes mediated the association between education and CVD incidence, accounting for 26% of the association (13.9, 6.9, and 5.2%, respectively). Sensitivity analyses showed that hypertension was the strongest mediator (average causal mediation effect [95% CI] = increase of 2170 days free of CVD events [711, 4520]). The association between education and CVD incidence is partially mediated by hypertension, BMI, and diabetes. Interventions to decrease the prevalence of these risk factors could contribute to diminish the CVD inequalities associated with educational level. |
format | Online Article Text |
id | pubmed-5620039 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-56200392017-10-11 The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index Dégano, Irene R. Marrugat, Jaume Grau, Maria Salvador-González, Betlem Ramos, Rafel Zamora, Alberto Martí, Ruth Elosua, Roberto Sci Rep Article Education and cardiovascular disease (CVD) are inversely associated but the mediating factors have not been totally elucidated. Our aim was to analyze the mediating role of modifiable risk factors. Cohort study using the REGICOR population cohorts. Participants without previous CVD were included (n = 9226). Marginal structural models were used to analyze the association between education and CVD incidence at 6 years of follow-up. Mediation by modifiable risk factors (diabetes, dyslipidemia, hypertension, smoking, body mass index, and physical activity) was assessed using the counterfactual framework. Participants with a university degree had a CVD incidence hazard ratio (HR) of 0.51 (95% confidence interval (CI) = 0.30, 0.85), compared to those with primary or lower education. Only hypertension, BMI, and diabetes mediated the association between education and CVD incidence, accounting for 26% of the association (13.9, 6.9, and 5.2%, respectively). Sensitivity analyses showed that hypertension was the strongest mediator (average causal mediation effect [95% CI] = increase of 2170 days free of CVD events [711, 4520]). The association between education and CVD incidence is partially mediated by hypertension, BMI, and diabetes. Interventions to decrease the prevalence of these risk factors could contribute to diminish the CVD inequalities associated with educational level. Nature Publishing Group UK 2017-09-28 /pmc/articles/PMC5620039/ /pubmed/28959022 http://dx.doi.org/10.1038/s41598-017-10775-3 Text en © The Author(s) 2017 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Dégano, Irene R. Marrugat, Jaume Grau, Maria Salvador-González, Betlem Ramos, Rafel Zamora, Alberto Martí, Ruth Elosua, Roberto The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index |
title | The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index |
title_full | The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index |
title_fullStr | The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index |
title_full_unstemmed | The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index |
title_short | The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index |
title_sort | association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620039/ https://www.ncbi.nlm.nih.gov/pubmed/28959022 http://dx.doi.org/10.1038/s41598-017-10775-3 |
work_keys_str_mv | AT deganoirener theassociationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT marrugatjaume theassociationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT graumaria theassociationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT salvadorgonzalezbetlem theassociationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT ramosrafel theassociationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT zamoraalberto theassociationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT martiruth theassociationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT elosuaroberto theassociationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT deganoirener associationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT marrugatjaume associationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT graumaria associationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT salvadorgonzalezbetlem associationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT ramosrafel associationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT zamoraalberto associationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT martiruth associationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex AT elosuaroberto associationbetweeneducationandcardiovasculardiseaseincidenceismediatedbyhypertensiondiabetesandbodymassindex |