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Educational attainment may improve cardiovascular risk factors and outcomes


Increased educational attainment during childhood is associated with a reduction in heart disease and improvements in several cardiovascular risk factors in adulthood, according to a study published June 25 in the open-access journal PLOS Medicine by Rita Hamad of the University of California San Francisco, United States and colleagues. As noted by the authors, the findings suggest that policies to increase educational attainment could reduce the burden of heart disease at the population level.

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.


Research Article


Funding for this study was provided by the National Institutes of Health (UL1 TR001085 via a pilot grant from the Stanford Clinical and Translational Science Award to Spectrum, K08 HL132106 to RH, K01 AG047280 to DHR, and RF1 AG056164 to MMG) ( This work was also supported by a grant from the American Educational Research Association, which receives funds for its AERA Grants Program from the National Science Foundation under NSF Grant #DRL-0941014 ( The HRS is sponsored by the National Institute on Aging (U01 AG009740) and is conducted by the University of Michigan. Publication was made possible in part by support from the UCSF Open Access Publishing Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.


Hamad R, Nguyen TT, Bhattacharqya J, Glymour MM, Rehkopf DH (2019) Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis. PLoS Med 16(6): e1002834.

Image Credit: DariuszSankowski, Pixabay

Author Affiliations:

Philip R. Lee Institute for Health Policy Studies, Department of Family & Community Medicine, University of California San Francisco, San Francisco, California, United States of America

Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America

Department of Medicine, Stanford University, Stanford, California, United States of America

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