Abhinav Goyal|Deepak L. Bhatt|Philippe Gabriel Steg|Bernard J. Gersh|Mark J. Alberts|E. Magnus Ohman|Ramón Corbalán|Kim A. Eagle|Efraín Gaxiola|Runlin Gao|Shinya Goto|Ralph B. D’Agostino|Robert M. Califf|Sidney C. Smith|Peter Wilson
Attained Educational Level and Incident Atherothrombotic Events in Low- and Middle-Income Compared With High-Income Countries
studies report protective effect higher attained educational level ael cardiovascular outcomes however studies conducted highincome countries hics lack representation low middleincome countries lmics bear 80 global burden cardiovascular diseasethe reduction atherothrombosis continued health reach registry prospective study 67 888 subjects either established atherothrombotic coronary cerebrovascular andor peripheral arterial disease multiple atherothrombotic risk factors enrolled 5587 physician practices 44 countries baseline ael 0 8 years 9 12 years trade technical school university selfreported 61 332 subjects outcomes included baseline prevalence atherothrombotic risk factors rate incident cardiovascular events cardiovascular death nonfatal myocardial infarction nonfatal stroke 23 months across ael groups stratified sex world region lmics hics educational attainment inversely associated age diabetes mellitus directly associated hypercholesterolemia subjects however risk factors obesity smoking hypertension baseline burden vascular disease ael protective inversely associated hics protective lmics protective effect greater ael incident cardiovascular events strongest men hics p00001 modest women hics p00026 men lmics p0082 essentially absent women lmics p032in contrast hics higher ael may protective cardiovascular events lmics particularly women