Dienhart Christiane, Gostner Isabella, Frey Vanessa, Aigner Elmar, Iglseder Bernhard, Langthaler Patrick, Paulweber Bernhard, Trinka Eugen, Wernly Bernhard
Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria.
Department of Cardiology & Nephrology, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria.
Front Cardiovasc Med. 2024 Oct 11;11:1345277. doi: 10.3389/fcvm.2024.1345277. eCollection 2024.
The association between education and atherosclerotic cardiovascular disease (ASCVD) has been well described for decades. Nevertheless, most cardiovascular risk models, including SCORE2, still do not take educational status into account even if this factor is easily assessed and costs nothing to acquire. Using carotid plaques as a proxy for ASCVD, we analysed educational status as associated with carotid plaque development, to determine if the relationship remains, how it relates to traditional risk factors and, how it impacts the European cardiovascular risk model, SCORE2. Our study also provides further data on plaque development in a well-characterised population nearly equally weighted by gender.
9,083 subjects (51% female, 49% male) from the Paracelsus 10,000 cohort, underwent a carotid doppler duplex as part of thorough screening for subclinical ASCVD. Well over 90% of carotid doppler duplex examinations were performed by the same experienced clinician. Subjects were then classified by educational status using the Generalized International Standard Classification of Education. Plaque absence or presence was dichotomised and variables analysed using regression modelling to examine educational status relative to cardiovascular risk factors and with respect to the SCORE2 model.
Using medium educational status as a reference, subjects in our cohort with low educational status had higher odds, while subjects with high educational status had lower odds for carotid plaques compared to subjects with medium education (aOR 1.76 95%CI 1.50-2.06; and 0.0.63 95%CI 0.57-0.70, respectively). Even after adjusting for common risk factors including metabolic syndrome and SCORE2, the relationship was maintained. Furthermore, when comparing the potential predictive power of SCORE2 alone and plus educational status using the Akaike information criterion, we showed a 'better fit' when educational status was added.
Measuring educational status is cost-free and easy for clinicians to obtain. We believe cardiovascular risk prediction models such as SCORE2 may more accurately reflect individual risk if educational status is also taken into account. Additionally, we believe clinicians need to understand and appropriately address educational status as a risk factor, to better quantify individual risk and take appropriate measures to reduce risk so that the association may finally be broken.
教育与动脉粥样硬化性心血管疾病（ASCVD）之间的关联已被详细描述了数十年。然而，大多数心血管风险模型，包括SCORE2，即使教育状况这一因素易于评估且获取成本为零，仍未将其纳入考虑。我们以颈动脉斑块作为ASCVD的替代指标，分析教育状况与颈动脉斑块形成的关联，以确定这种关系是否依然存在、它与传统风险因素如何相关，以及它如何影响欧洲心血管风险模型SCORE2。我们的研究还提供了关于一个特征明确且性别比例几乎相等的人群中斑块形成的进一步数据。
来自帕拉塞尔苏斯一万人群队列的9083名受试者（51%为女性，49%为男性）接受了颈动脉多普勒双功超声检查，作为亚临床ASCVD全面筛查的一部分。超过90%的颈动脉多普勒双功超声检查由同一位经验丰富的临床医生进行。然后使用通用国际教育标准分类法按教育状况对受试者进行分类。将有无斑块进行二分法处理，并使用回归模型分析变量，以研究教育状况相对于心血管风险因素以及与SCORE2模型的关系。
以中等教育状况为参照，与中等教育程度的受试者相比，我们队列中低教育程度的受试者出现颈动脉斑块的几率更高，而高教育程度的受试者出现颈动脉斑块的几率更低（调整后的比值比分别为1.76[95%置信区间1.50 - 2.06]和0.63[95%置信区间0.57 - 0.70]）。即使在对包括代谢综合征和SCORE2在内的常见风险因素进行调整后，这种关系依然存在。此外，当使用赤池信息准则比较单独的SCORE2以及加上教育状况后的潜在预测能力时，我们发现加入教育状况后“拟合度更好”。
测量教育状况对临床医生来说成本为零且易于获取。我们认为，如果也将教育状况纳入考虑，像SCORE2这样的心血管风险预测模型可能会更准确地反映个体风险。此外，我们认为临床医生需要了解并适当处理教育状况这一风险因素，以便更好地量化个体风险并采取适当措施降低风险，从而最终打破这种关联。
