Education and coronary heart disease: mendelian randomisation study
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Abstract
Abstract Objectives To determine whether educational attainment is a causal risk factor in the development of coronary heart disease. Design Mendelian randomization study, where genetic data are used as proxies for education, in order to minimize confounding. A two-sample design was applied, where summary level genetic data was analysed from two publically available consortia. Setting In the main analysis, we analysed genetic data from two large consortia (CARDIoGRAM and SSGAC), comprising of 112 cohorts from predominantly high-income countries. In addition, we also analysed genetic data from 7 additional large consortia, in order to identify putative causal mediators. Participants The main analysis was of 589 377 men and women, predominantly of European origin. Exposure A one standard deviation increase in the genetic predisposition towards higher education (i.e. 3.6 years of additional schooling). This was measured by 162 genetic variants that have been previously associated with education. Main outcome Combined fatal and nonfatal coronary heart disease (63 746 events). Results 3.6 years of additional education lowered the risk of coronary heart disease by a third (odds ratio = 0.67, 95% confidence interval [CI], 0.59 to 0.77, p=0.01). Equivalent increases in education were also causally associated with reductions in smoking, BMI and improvements in blood lipid profiles. Conclusions More time spent in education is causally associated with a large reduction in the risk of coronary heart disease. This may be partly explained by changes to smoking, BMI and a blood lipids. These findings offer support for policy interventions that increase education, in order to also reduce the burden of cardiovascular disease.
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There is clear evidence from both MR and the natural experiment of an increase in the school leaving age that an increase in the number of years in education has a causal protective effect on health behaviours such as smoking.
“For example, there is clear evidence from both MR and the natural experiment of an increase in the school leaving age that an increase in the number of years in education has a causal protective effect on health behaviours such as smoking.156–160”
From Mendelian randomization (2022) · cites this paper as [156]
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- Authors
- Tillmann, T., Vaucher, J., Okbay, A., Pikhart, H., Peasey, A., Kubinova, R., Pajak, A., Tamosiunas, A., Malyutina, S., Hartwig, F. P., Fischer, K., Veronesi, G., Palmer, T., Bowden, J., Davey Smith, G., Bobak, M., & Holmes, M. V.
- Affiliations
- University College London (GB)
- Centre Hospitalier Universitaire Vaudois (CH)
- Vrije Universiteit Amsterdam (NL)
- Novosibirsk State Medical University (RU)
- Universidade Federal de Pelotas (BR)
- University of Tartu (EE)
- University of Insubria (IT)
- Lancaster University (GB)
- University of Bristol (GB)
- National Institute for Health and Care Research (GB)
- Corresponding author
- Tillmann, Taavi
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2017-08-30
- Volume
- 358
- Pages
- j3542
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC5594424
- OpenAlex
- W2593125540
- Cited by
- 225
- References
- 65
- Citations by year
- 2026: 4 · 2025: 23 · 2024: 16 · 2023: 27 · 2022: 14 · 2021: 25 · 2020: 64 · 2019: 23 · 2018: 19 · 2017: 10
- FWCI
- 21.00
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- BMJ (publishedVersion, cc-by)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- SERVAL (Université de Lausanne) (publishedVersion, other-oa)
- Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion, cc-by-nc-nd)
- IRIS (submittedVersion, public-domain)
- Bristol Research (University of Bristol) (submittedVersion, cc-by)
- Jagiellonian University Repository (Jagiellonian University) (submittedVersion, cc-by-nc-nd)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- IrInSubria (University of Insubria) (submittedVersion)
- Lithuanian University of Health Sciences (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Explore Bristol Research (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- National Science Foundation
- John D. and Catherine T. MacArthur Foundation (064947/Z/01/Z)
- Wellcome Trust (064947, 106554/Z/14/Z, MC_UU_12013/1, 106554, WT0 81081, 064947 ⁄Z⁄ 01 ⁄ Z)
- National Institute for Health and Care Research (MC_UU_12013/1)
- University of Oxford
- European Commission (278913, 242244)
- University of Bristol (MC_UU_12013/1, MC_UU_12013)
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (155086)
- Russian Science Foundation (14-45-00030, 00030)
- Medical Research Council (MC_UU_12013, MCUU12013/1, MR/N501906/1)
- H2020 European Research Council (647648)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Social Sciences › Sociology and Political Science › Intergenerational and Educational Inequality Studies
- Keywords
- educational attainment, coronary artery disease, causal risk factors, cardiovascular risk factors, smoking, body mass index, serum lipids, educational inequality in health
- MeSH terms
- Coronary Disease, Educational Status, Europe, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Risk Factors, Social Class, Genome-Wide Association Study, Mendelian Randomization Analysis, Observational Studies as Topic
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