Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China; Guangdong Engineering Research Center for Light and Health, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China.
Cardiology Department, The First affiliated hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yue Xiu, GuangZhou 510080, GuangDong, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), PR China.
Int J Cardiol. 2021 Feb 1;324:115-121. doi: 10.1016/j.ijcard.2020.09.068. Epub 2020 Oct 2.
We aim to characterize the nature and magnitude of the prospective association between education and incident heart failure (HF) in the Atherosclerosis Risk in Communities (ARIC) Study and investigate any causal relevance to the association between them.
The final sample size was 12,315 in this study. Baseline characteristics between education levels were compared using 1-way ANOVA test, the Kruskal-Wallis test, or the χ2 test. We used the Kaplan-Meier estimate to compute the cumulative incident of HF by education levels and the difference in estimate was compared using the log-rank test. Cox hazard regression models were used to explore the association between education levels and incident HF. Two-sample Mendelian randomization (MR) based on publicly available summary-level data from genome-wide association studies (GWASs) was used to estimate the causal influence of the education and incident HF.
During a median follow-up of 25.1years, 2453 cases (19.9%) of incident HF occurred. After multiple adjustments in the final model, participants in the intermediate and advanced education levels were still associated with 18% and 21% decreased rate of incident HF separately. In MR analysis, we detected a protective causal association between education and HF (P=0.005).
Participants with higher education levels were associated with a decreased rate of incident HF. There was a causal association between education and HF.
我们旨在描述教育与社区动脉粥样硬化风险研究（ARIC）中事件性心力衰竭（HF）之间前瞻性关联的性质和程度，并探讨它们之间关联的任何因果关系。
本研究的最终样本量为 12315 人。使用单因素方差分析、克鲁斯卡尔-沃利斯检验或卡方检验比较不同教育水平之间的基线特征。我们使用 Kaplan-Meier 估计来计算按教育水平划分的 HF 累积发生率，并使用对数秩检验比较估计值的差异。使用 Cox 风险回归模型探讨教育水平与事件性 HF 之间的关联。使用基于全基因组关联研究（GWAS）的公开汇总水平数据的双样本孟德尔随机化（MR）来估计教育和事件性 HF 之间的因果影响。
在中位随访 25.1 年期间，发生了 2453 例（19.9%）事件性 HF。在最终模型中进行多次调整后，中高等教育水平的参与者仍分别与 18%和 21%的 HF 发生率降低率相关。在 MR 分析中，我们检测到教育与 HF 之间存在保护因果关系（P=0.005）。
教育水平较高的参与者与 HF 发生率降低率相关。教育与 HF 之间存在因果关系。
