Good education does not always translate into a healthy lifestyle

Educational level counts when it comes to heart health, according to previous studies. Research have shown that men with more educational tend to have lower cardiovascular risk and suffer from fewer cardiovascular events such as stroke and heart attack. However, this seems to be true only in developed countries but not in countries which are less developed and with less resources, the so-called low- and middle-income countries (LMICs). This is according to the results from a new and still ongoing research study called Reduction of Atherothrombosis for Continued Health (REACH).

REACH is studying more than 60,000 people in 44 countries. The subjects were classified into 4 groups based on their educational attainment: zero to eight years, nine to 12 years, trade or technical school, and university.

The results of REACH showed that educational level is correlated with many cardiovascular risk factors such as age, diabetes mellitus, and cholesterol levels. High educational attainment even provides some sort of cardiovascular protection with regards to the risk factors obesity, smoking, hypertension, and baseline vascular disease burden. However, this relationship is only true for subjects in high-income countries, strongest in men and more modest but still significant in women of these countries.

Looking at subjects from LMICs gives a completely different picture. The protective effect of education is much less among men and completely absent among women in these countries.

According to REACH researcher Dr. Abhinav Goyal of the Emory School of Medicine in Atlanta, GA:

“Most of the studies that have been conducted in the past 20 years have been conducted in the developed world and Western countries. We got good information from those studies, indicating that higher education protects against cardiovascular events [in the developed world], but the scope of cardiovascular disease on a global scale has shifted such that over 80% of the burden in the world from cardiovascular disease is happening in developing economies or low- and middle-income countries.”

So why is education less protective in women than in men?

The answer is in gender-specific smoking habits. Whereas more educated men are less likely to smoke, more educated women are more likely to smoke.

And why is education less protective in LMICs? The researchers explain:

“…wealthy countries, higher education generally leads to better incomes, a better standard of living, and a higher likelihood that the individual will follow through on healthy behaviors, such as not smoking, nutrition, and exercises. Also, better-educated people in highly developed countries are more likely than less educated people to know how to navigate the healthcare system and follow through on their healthcare providers’ recommendations. But in low- to middle-income countries, especially for women, higher education frequently does not lead to higher income or an ability to easily access healthcare…”

Doctors are advised not to make assumptions about educated people, especially in less developed countries. Being educated does not mean being well-informed about healthy lifestyle behaviors.