Educational attainment and risk of stroke and myocardial infarction

Background: Prior reports have suggested that low educational attainment could be associated with higher incidence of some of the cardiovascular conditions. Material/Methods: We evaluated the association of educational attainment (≥12 years <12 years) with the incidence of fatal strokes, ischemic stroke, intracerebral hemorrhage, and myocardial infarction in a cohort of 21,443 United States adults who participated in either the First National Health and Nutrition Examination Survey (NHANES-I) Epidemiologic Follow-up Study (NHEFS) or the Second National Health and Nutrition Examination Survey Mortality Follow-up Study (NHANES-II). Cox proportional hazards analyses were used to examine the relationships. Results: During a mean follow-up period of 15.2±4.6 years, the risk for all fatal strokes was increased in persons who reported less than 12 years of education. The increased risk was more prominent in persons aged 50 years or less (relative risk [RR], 2.6; 95% confidence interval [CI], 1.1-6.0) compared with persons aged greater than 50 years (RR, 1.3, 95% CI, 1.0-1.6). A higher risk of myocardial infarction associated with less than 12 years of education was observed in both persons aged 50 years or less (RR 1.7, 95% CI 1.2-2.4) and those aged greater than 50 years (RR 1.3, 95% CI 1.1-1.5). The risk for fatal intracerebral hemorrhages (RR 2.0, 95% CI 1.1-3.5) was higher in persons with less than 12 years of education (no significant interaction demonstrated with age). Conclusions: Educational attainment has a significant effect on the risk for stroke and myocardial infarction, independent of socioeconomic status and other cardiovascular risk factors.