J Prev Med Public Health.  2016 Jul;49(4):220-229. 10.3961/jpmph.16.005.

The Impact of Educational Status on 10-Year (2004-2014) Cardiovascular Disease Prognosis and All-cause Mortality Among Acute Coronary Syndrome Patients in the Greek Acute Coronary Syndrome (GREECS) Longitudinal Study

• Notara V
• Panagiotakos DB
• Kogias Y
• Stravopodis P
• Antonoulas A
• Zombolos S
• Mantas Y
• Pitsavos C
• GREECS Study Investigators

• KMID: 2348489
• DOI: http://doi.org/10.3961/jpmph.16.005

Abstract

OBJECTIVES
The association between educational status and 10-year risk for acute coronary syndrome (ACS) and all-cause mortality was evaluated.
METHODS
From October 2003 to September 2004, 2172 consecutive ACS patients from six Greek hospitals were enrolled. In 2013 to 2014, a 10-year follow-up (2004-2014) assessment was performed for 1918 participants (participation rate, 88%). Each patient's educational status was classified as low (<9 years of school), intermediate (9 to 14 years), or high (>14 years).
RESULTS
Overall all-cause mortality was almost twofold higher in the low-education group than in the intermediate-education and high-education groups (40% vs. 22% and 19%, respectively, p<0.001). Additionally, 10-year recurrent ACS events (fatal and non-fatal) were more common in the low-education group than in the intermediate-education and high-education groups (42% vs. 30% and 35%, p<0.001), and no interactions between sex and education on the investigated outcomes were observed. Moreover, patients in the high-education group were more physically active, had a better financial status, and were less likely to have hypertension, diabetes, or ACS than the participants with the least education (p<0.001); however, when those characteristics and lifestyle habits were accounted for, no moderating effects regarding the relationship of educational status with all-cause mortality and ACS events were observed.
CONCLUSIONS
A U-shaped association may be proposed for the relationship between ACS prognosis and educational status, with participants in the low-education and high-education groups being negatively affected by other factors (e.g., job stress, depression, or loneliness). Public health policies should be aimed at specific social groups to reduce the overall burden of cardiovascular disease morbidity.

Keyword

Cardiovascular disease; Acute coronary syndrome; Educational staus; Social class; Risk factors; Unhealthy behaviors

MeSH Terms

Acute Coronary Syndrome*
Cardiovascular Diseases*
Depression
Education
Educational Status*
Follow-Up Studies
Humans
Hypertension
Life Style
Longitudinal Studies*
Mortality*
Prognosis*
Public Health
Risk Factors
Social Class