Understanding the consequences of education inequality on cardiovascular disease: mendelian randomisation study.

Details

Serval ID
serval:BIB_E4E48183C974
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Understanding the consequences of education inequality on cardiovascular disease: mendelian randomisation study.
Journal
BMJ
Author(s)
Carter A.R., Gill D., Davies N.M., Taylor A.E., Tillmann T., Vaucher J., Wootton R.E., Munafò M.R., Hemani G., Malik R., Seshadri S., Woo D., Burgess S., Davey Smith G., Holmes M.V., Tzoulaki I., Howe L.D., Dehghan A.
ISSN
1756-1833 (Electronic)
ISSN-L
0959-8138
Publication state
Published
Issued date
22/05/2019
Peer-reviewed
Oui
Volume
365
Pages
l1855
Language
english
Notes
Publication types: Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
To investigate the role of body mass index (BMI), systolic blood pressure, and smoking behaviour in explaining the effect of education on the risk of cardiovascular disease outcomes.
Mendelian randomisation study.
UK Biobank and international genome-wide association study data.
Predominantly participants of European ancestry.
Educational attainment, BMI, systolic blood pressure, and smoking behaviour in observational analysis, and randomly allocated genetic variants to instrument these traits in mendelian randomisation.
The risk of coronary heart disease, stroke, myocardial infarction, and cardiovascular disease (all subtypes; all measured in odds ratio), and the degree to which this is mediated through BMI, systolic blood pressure, and smoking behaviour respectively.
Each additional standard deviation of education (3.6 years) was associated with a 13% lower risk of coronary heart disease (odds ratio 0.86, 95% confidence interval 0.84 to 0.89) in observational analysis and a 37% lower risk (0.63, 0.60 to 0.67) in mendelian randomisation analysis. As a proportion of the total risk reduction, BMI was estimated to mediate 15% (95% confidence interval 13% to 17%) and 18% (14% to 23%) in the observational and mendelian randomisation estimates, respectively. Corresponding estimates were 11% (9% to 13%) and 21% (15% to 27%) for systolic blood pressure and 19% (15% to 22%) and 34% (17% to 50%) for smoking behaviour. All three risk factors combined were estimated to mediate 42% (36% to 48%) and 36% (5% to 68%) of the effect of education on coronary heart disease in observational and mendelian randomisation analyses, respectively. Similar results were obtained when investigating the risk of stroke, myocardial infarction, and cardiovascular disease.
BMI, systolic blood pressure, and smoking behaviour mediate a substantial proportion of the protective effect of education on the risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of cardiovascular disease attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.
Keywords
Adult, Aged, Blood Pressure, Body Mass Index, Cardiovascular Diseases/etiology, Educational Status, Female, Humans, Male, Mendelian Randomization Analysis, Middle Aged, Multivariate Analysis, Odds Ratio, Risk Factors, Smoking/adverse effects, Socioeconomic Factors, United Kingdom
Pubmed
Web of science
Open Access
Yes
Create date
18/06/2019 17:02
Last modification date
20/08/2019 16:08
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