Inverse Association between Educational Status and Coronary CT Calcium Scores: Should We Reflect This in Our ASCVD Risk Assumptions?

Christiane Dienhart (), Bernhard Paulweber, Vanessa N. Frey, Bernhard Iglseder, Eugen Trinka, Patrick Langthaler, Elmar Aigner, Marcel Granitz and Bernhard Wernly
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Christiane Dienhart: Department of Internal Medicine I, Paracelsus Medical University, 5020 Salzburg, Austria
Bernhard Paulweber: Department of Internal Medicine I, Paracelsus Medical University, 5020 Salzburg, Austria
Vanessa N. Frey: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria
Bernhard Iglseder: Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria
Eugen Trinka: Department of Internal Medicine I, Paracelsus Medical University, 5020 Salzburg, Austria
Patrick Langthaler: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria
Elmar Aigner: Department of Internal Medicine I, Paracelsus Medical University, 5020 Salzburg, Austria
Marcel Granitz: CT und MRT Institut, DBS Gmbh, 5020 Salzburg, Austria
Bernhard Wernly: Institute for General and Preventive Medicine, Paracelsus Medical University, 5020 Salzburg, Austria

IJERPH, 2023, vol. 20, issue 12, 1-9

Abstract: Education is not a factor included in most cardiovascular risk models, including SCORE2. However, higher education has been associated with lower cardiovascular morbidity and mortality. Using CACS as a proxy for ASCVD, we studied the association between CACS and educational status. Subjects, aged 40–69, from the Paracelsus 10,000 cohort, who underwent calcium scoring as part of screening for subclinical ASCVD, were classified into low, medium, and high educational status using the Generalized International Standard Classification of Education. CACS was dichotomised as either 0 or >0 for logistic regression modelling. Our analysis showed that higher educational status was associated with higher odds for 0 CACS (aOR 0.42; 95%CI 0.26–0.70; p = 0.001). However, there was no statistically significant association between the levels of total, HDL or LDL cholesterol and educational status, nor any statistical differences in HbA1c. SCORE2 did not differ between the three educational categories (4 ± 2% vs. 4 ± 3% vs. 4 ± 2%; p = 0.29). While our observations confirmed the relationship between increased educational status and lower ASCVD risk, the effect of educational status was not mediated via its impact on classical risk factors in our cohort. Thus, perhaps educational status should be taken into account to more accurately reflect individual risk in cardiovascular risk models.

Keywords: cardiovascular risk scores; educational status; SCORE2; cardiovascular health; CT calcium score (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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