© 1993 Oxford University Press
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The Association of Education with Coronary Heart Disease Mortality in the USSR Lipid Research Clinics Study
* Departments of Nutrition, Blostatistics, and Epidemiology, School of Public Health, Suite 203, NCNB Plaza University of North Carolina Chapel Hill, NC 27514, USA
** Institute of Preventive Cardiology, Russian Research Center of Preventive Medicine Moscow, Russia
Department of Biochemistiy, Institute of Experimental Medicine St Petersburg, Russia
There is a strong inverse association between educational attainment and coronary heart disease (CHD) mortality in men in the USSR Lipid Research Clinics (LRC) Study. Less educated men were characterized by higher mean blood pressure, high density lipoprotein cholesterol (HDL-C), cigarettes smoked and by lower mean low density lipoprotein cholesterol (LDL-C) and body mass index (BMI). With respect to nutritional variables, less educated men were characterized by higher mean energy per kg body weight and alcohol intake and by lower mean intake of fat, saturated, mono- and polyunsaturated fatty acids, cholesterol, sucrose, and other sugars. The Keys score closely predicted the differences in plasma cholesterol among the educational groups in the randomly selected sample. In men without CHD at entry, the age and clinic-adjusted relative risk for CHD mortality was 2.4 for the least educated compared with the most educated group; on adjusting for systolic blood pressure, HDL-C, LDL-C, BMI, alcohol intake and number of cigarettes, the relative risk was reduced to 1.9. These data indicate that only 22% of the twofold excess of CHD mortal ity associated with low education was statistically attributable to the major risk factors. The failure to explain more of the education-CHD mortality gradient in the USSR LRC cohort was similar to observations from cohort studies in Great Britain and the US. Other correlates of low education must be explored to explain the association.
Received 1 September 1992
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