Time trends in the relation between the achieved education and the cardiovascular risk factors prevalence and control in general population and in persons with coronary heart disease
Authors: Bruthans J , Mayer O , Sulc P , Wohlfahrt P , Lanska V , Cifkova R 
Published: November 2020

Abstract

Background
Achieved education is the most consistent and powerful socioeconomic status index and the differences in cardiovascular mortality (CV) according to achieved education in the Czech Republic are over a long period among most pronounced in Europe. Higher prevalence of CV risk factors in less educated is the major factor behind their higher CV morbidity and mortality.

Purpose
To analyse the changes in prevalence and control of CV risk factors according to achieved education in general population and in patients with stable CHD and their impact on CV mortality.

Methods
Based on data of 15 590 persons from 7 cross sectional epidemiological surveys carried through the Czech MONICA and post-MONICA project in 1985–2018 in identical 6 districts of the Czech Republic (general population) and on data of 2129 patients from 5 independent descriptive surveys of the Czech EUROASPIRE study in 1995–2018 (patients with stable CHD) time trends of major CV risk factors and their control in respondents with basic, secondary and university education were compared.

Results
The persons from general population as well as patients with CHD with higher education had consistently lower BMI and lower prevalence of obesity, the differences increased in due time (p&lt;0,001), the prevalence of obesity increased in all educational strata (p&lt;0,001). The total and non-HDL cholesterol were higher in lower educational population strata (p&lt;0,01), but not in CHD patients, there was a very pronounced continuous decrease in all educational strata (p&lt;0,001 for trend). Population systolic and diastolic blood pressures and prevalence of hypertension were higher in men and women with basic education (p&lt;0,01) and decreased during the analysed period (p&lt;0,001). In CHD patients the blood pressure was higher only in women. The prevalence of smoking was higher in men with basic education and decreased in all educational strata (p&lt;0,0001), in women the prevalence of smoking increased in women with basic and decreased in women with secondary and university education (p&lt;0,0001), in CHD patients the prevalence of smoking was lower and did not differ according to education. Prevalence of diabetes and of sedentary life style increased and was more prevalent in general as well as in CHD population in persons with lower education.

Conclusion
CV risk gradient in general population and in CHD patients decreased with level of education achieved, was present during the whole analysed period and became more pronounced in the 2016–18 survey. The education based differences were more pronounced in factors influenced by lifestyle (BMI, smoking) and less in factors influenced also by medical therapies (blood pressure, cholesterol levels). The impact on CV mortality is to be expected more pronounced in general CV prevention and less in already treated population. Observation of healthy life style remains a basic problem in CV prevention, particularly in persons with elementary education.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Agency for Medical Research, Ministry of Health of the Czech Republic