2026-04-13T01:10:18Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/35342025-10-24T10:58:25Zcom_2072_378068com_2072_378040col_2072_378090

The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index Dégano, Irene R Marrugat de la Iglesia, Jaume Grau, Maria Salvador-González, Betlem Ramos, Rafel Zamora, Alberto Elosua, Roberto Martí Lluch, Ruth Diabetis Hipertensió Sistema cardiovascular - Malalties Educació Pes corporal - Regulació DISEASES::Nutritional and Metabolic Diseases::Metabolic Diseases::Glucose Metabolism Disorders::Diabetes Mellitus DISEASES::Cardiovascular Diseases::Vascular Diseases::Hypertension HEALTH CARE::Environment and Public Health::Public Health::Epidemiologic Measurements::Biometry::Anthropometry::Body Mass Index DISEASES::Cardiovascular Diseases SCIENCE AND HEALTH::Health Sciences, Technology and Innovation Management::Science, Technology and Society::Population Education ENFERMEDADES::enfermedades nutricionales y metabólicas::enfermedades metabólicas::trastornos del metabolismo de la glucosa::diabetes mellitus ENFERMEDADES::enfermedades cardiovasculares::enfermedades vasculares::hipertensión ATENCIÓN DE SALUD::ambiente y salud pública::salud pública::medidas epidemiológicas::biometría::antropometría::índice de masa corporal ENFERMEDADES::enfermedades cardiovasculares CIENCIA Y SALUD::gestión de ciencia, tecnología e innovación en salud::ciencia, tecnología y sociedad::educación de la población Malalties cardiovasculars; Nivell Educacional; Diabetis Enfermedades cardiovasculares; Nivel Educacional; Diabetes Cardiovascular Diseases; Educational Level; Diabetes Education and cardiovascular disease (CVD) are inversely associated but the mediating factors have not been totally elucidated. Our aim was to analyze the mediating role of modifiable risk factors. Cohort study using the REGICOR population cohorts. Participants without previous CVD were included (n = 9226). Marginal structural models were used to analyze the association between education and CVD incidence at 6 years of follow-up. Mediation by modifiable risk factors (diabetes, dyslipidemia, hypertension, smoking, body mass index, and physical activity) was assessed using the counterfactual framework. Participants with a university degree had a CVD incidence hazard ratio (HR) of 0.51 (95% confidence interval (CI) = 0.30, 0.85), compared to those with primary or lower education. Only hypertension, BMI, and diabetes mediated the association between education and CVD incidence, accounting for 26% of the association (13.9, 6.9, and 5.2%, respectively). Sensitivity analyses showed that hypertension was the strongest mediator (average causal mediation effect [95% CI] = increase of 2170 days free of CVD events [711, 4520]). The association between education and CVD incidence is partially mediated by hypertension, BMI, and diabetes. Interventions to decrease the prevalence of these risk factors could contribute to diminish the CVD inequalities associated with educational level. 2025-10-24T10:58:25Z 2025-10-24T10:58:25Z 2025-10-24T10:58:25Z 2018-06-19T08:23:55Z 2018-06-19T08:23:55Z 2017-09-28 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://hdl.handle.net/11351/3534 Scientific Reports;7(1) https://www.nature.com/articles/s41598-017-10775-3 Atribución-NoComercial-SinDerivadas 3.0 España http://creativecommons.org/licenses/by-nc-nd/3.0/es/ info:eu-repo/semantics/openAccess Nature Publishing Group Scientia