The association of coronary risk factors with educational achievement: Results of the ARIC-MONICA collaborative studies

The present study examines the association between educational achievement and the three major coronary heart disease risk factors: total cholesterol, blood pressure, and cigarette smoking. It compares individuals sampled in three US populations in the Atherosclerosis Risk in Community (ARIC) study (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, Minnesota) and in three European MONICA (Monitoring of trends and determinants in cardiovascular diseases) populations (Augsburg (Germany), Bremen (Germany), and Vaud/Fribourg (Switzerland)). All populations include both men and women, ages 45 to 64 years in the ARIC study and ages 25 to 64 years in the MONICA study. For this report, the associations were assessed descriptively and graphically. Quantitative assessments were obtained by calculating gender-, center-, and education-specific odds ratios controlling for age. The findings indicate a pattern of relationships of educational achievement to the major risk factors: The least consistent association is with total cholesterol, a slight trend toward an inverse association with blood pressure (stronger for women) is observed, and the strongest inverse association is observed with smoking. The adjusted odds of prevalent cigarette smoking for individuals in the low-education group compared to those in the high group ranged from 1.6 to 2.2 across the ARIC and MONICA populations, within the age group of 45 to 64 years. The inverse associations of the risk factors with educational level of individuals in the ARIC populations are consistent with the current inverse association of coronary heart disease mortality with the educational profile by place of residence observed at the aggregate level in the United States.