THE ASSOCIATION OF EDUCATION WITH CORONARY HEART-DISEASE MORTALITY INTHE USSR LIPID RESEARCH CLINICS STUDY

There is a strong inverse association between educational attainment a nd coronary heart disease (CHD) mortality in men in the USSR Lipid Res earch Clinics (LRC) Study. Less educated men were characterized by hig her mean blood pressure, high density lipoprotein cholesterol (HDL-C), cigarettes smoked and by lower mean low density lipoprotein cholester ol (LDL-C) and body mass index (BMI). With respect to nutritional vari ables, less educated men were characterized by higher mean energy per kg body weight and alcohol intake and by lower mean intake of fat, sat urated, mono- and polyunsaturated fatty acids, cholesterol, sucrose, a nd other sugars. The Keys score closely predicted the differences in p lasma cholesterol among the educational groups in the randomly selecte d sample. In men without CHD at entry, the age and clinic-adjusted rel ative risk for CHD mortality was 2.4 for the least educated compared w ith the most educated group; on adjusting for systolic blood pressure, HDL-C, LDL-C, BMI, alcohol intake and number of cigarettes, the relat ive risk was reduced to 1.9. These data indicate that only 22% of the twofold excess of CHD mortality associated with low education was stat istically attributable to the major risk factors. The failure to expla in 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.