Chang, Choon Lan; (1997) Educational attainment and cardiovascular disease in young women. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This study examined the educational differences in CVD in young women, and sought explanations for the observed patterns and investigated the CVD risk factors. There are 2478 cases aged 15-49 years, and 6819 age-matched controls recruited between 1989 and 1995 from 15 countries in Africa, Asia, Latin America and Caribbean, and Eastern Europe. The results show that in Eastern Europe, risk of acute myocardial infarction (AMI) was higher in women with low education. But in non-European women AMI risk was higher in those with high education. Risk of ischaemic stroke was inversely related to education in all regions except Africa. Risks of ischaemic and unspecified stroke were positively associated with education in Africa. There were no clear patterns seen with haemorrhagic stroke except in Asia where an inverse association was observed. Adjustment for high blood pressure, smoking, use of oral contraceptives (OCs) and area of residence attenuated the educational gradients. Self-reported history of high blood pressure, diabetes, abnormal blood lipids, family history of premature heart attack, current use of OCs and heavy smoking were more strongly related to risk of AMI than to risk of stroke. Smoking was the dominant risk factor for AMI in Eastern Europe followed by history of abnormal blood lipids. Family histories of premature stroke and blood pressure problem in pregnancy were also found to be independent risk factors in both types of stroke. Heavy alcohol consumption significantly elevated the risk of both types of stroke in Eastern Europe but not in non- European regions. The study concluded that the pattern of CVD particularly AMI, according to educational attainment, in a country is related to the stage of economic development of that country. The educational differences in CVD could partly be explained by standard risk factors. The study has also shown that several CVD risk factors have similar relative importance as in Western populations.

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