The correlation between education and fewer heart
The correlation between education and fewer heart attacks was weaker among women in rich countries and men in lower- and middle-income countries.

Numerous studies have found a connection between education and the risk of heart disease and stroke. More educated people tend to have fewer heart attacks and other so-called cardiovascular events. But new research finds that the correlation doesn't apply everywhere.

Previous studies have been done almost entirely in richer, industrialized countries. Abhinav Goyal of Emory University in Atlanta wanted to see if that link between heart disease and education applied in low- and middle-income countries.

"So what we found is that there is a relationship between education level and cardiovascular events that differs both in terms of gender and in terms of world region," says Goyal.

The correlation between more education and fewer heart attacks, strokes, and other cardiovascular events was strongest among men in richer countries. The link was weaker among women in rich countries and men in lower- and middle-income countries.

"And then finally, when you looked at women in low- and middle-income countries, there was almost no difference - meaning that, unlike men in high-income countries, it does not appear that education is protective against cardiovascular events in women in low- and middle-income countries," says Goyal.

Educated people in richer countries may be less likely to have cardiovascular disease because they tend to avoid risky behaviors like smoking, or they eat better, or get better medical care. But in lower-income countries in Asia, Latin America, and the Middle East - where the people in this study live - many of those women are moving into urban areas, taking sedentary office jobs. They are increasingly being targeted by tobacco companies. And there may be social limits to what women can do.

"Because of some of the social constructs of some of the low- and middle-income countries, women are not as free to have access to the family income," says Goyal, "and their education may not necessarily translate to better employment, and then they may not be in a position always to seek health care and follow-through with those plans."  

Goyal's study suggests that it's wrong for physicians and policymakers to assume that just because people get more schooling they will automatically adopt a healthier lifestyle.

Dr. Abhinav Goyal's research appears in the journal Circulation, published by the American Heart Association. [It was based on data from the Reduction of Atherothrombosis for Continued Health (REACH) Registry.