Education protects against coronary heart disease and stroke independently of cognitive function: evidence from Mendelian randomization
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Supporting information
Supporting information
Author(s)
Gill, Dipender
Efstathiadou, A
Cawood, K
Tzoulaki, I
Dehghan, A
Type
Journal Article
Abstract
Background: There is evidence that education protects against cardiovascular disease. However, it is not known whether such an effect is independent of cognition.
Methods: We performed two-sample Mendelian randomization (MR) analyses to investigate the effect of education and cognition respectively, on risk of CHD and ischemic stroke. Additionally, we used multivariable MR to adjust for the effects of cognition and education in the respective analyses to measure the effects of these traits independently of each other.
Results: In unadjusted MR, there was evidence that education is causally associated with both CHD and stroke risk (CHD: OR 0.65 per 1-standard deviation [SD, 3.6 years] increase in education; 95% confidence interval [CI] 0.61-0.70, stroke: OR 0.77; 95% CI 0.69-0.86). This effect persisted after adjusting for cognition in multivariable MR (CHD: OR 0.76; 95% CI 0.65-0.89, stroke OR 0.74; 95% CI 0.59-0.92). Cognition had an apparent effect on CHD risk in unadjusted MR (OR per 1-SD increase 0.80; 95% CI 0.74-0.85), however after adjusting for education this was no longer observed (OR 1.03; 95% CI 0.86-1.25). Cognition did not have any notable effect on the risk of developing ischemic stroke, with (OR 0.97; 95% CI 0.87-1.08) or without adjustment for education (OR 1.04; 95% CI 0.79-1.36).
Conclusion: This study provides evidence to support that education protects against CHD and ischemic stroke risk independently of cognition, but does not provide evidence to support that cognition protects against CHD and stroke risk independently of education. These findings could have implications for education and health policy.
Methods: We performed two-sample Mendelian randomization (MR) analyses to investigate the effect of education and cognition respectively, on risk of CHD and ischemic stroke. Additionally, we used multivariable MR to adjust for the effects of cognition and education in the respective analyses to measure the effects of these traits independently of each other.
Results: In unadjusted MR, there was evidence that education is causally associated with both CHD and stroke risk (CHD: OR 0.65 per 1-standard deviation [SD, 3.6 years] increase in education; 95% confidence interval [CI] 0.61-0.70, stroke: OR 0.77; 95% CI 0.69-0.86). This effect persisted after adjusting for cognition in multivariable MR (CHD: OR 0.76; 95% CI 0.65-0.89, stroke OR 0.74; 95% CI 0.59-0.92). Cognition had an apparent effect on CHD risk in unadjusted MR (OR per 1-SD increase 0.80; 95% CI 0.74-0.85), however after adjusting for education this was no longer observed (OR 1.03; 95% CI 0.86-1.25). Cognition did not have any notable effect on the risk of developing ischemic stroke, with (OR 0.97; 95% CI 0.87-1.08) or without adjustment for education (OR 1.04; 95% CI 0.79-1.36).
Conclusion: This study provides evidence to support that education protects against CHD and ischemic stroke risk independently of cognition, but does not provide evidence to support that cognition protects against CHD and stroke risk independently of education. These findings could have implications for education and health policy.
Date Issued
2019-10-01
Date Acceptance
2019-09-04
Citation
International Journal of Epidemiology, 2019, 48 (5), pp.1468-1477
ISSN
0300-5771
Publisher
Oxford University Press (OUP)
Start Page
1468
End Page
1477
Journal / Book Title
International Journal of Epidemiology
Volume
48
Issue
5
Copyright Statement
© The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permitsunrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Subjects
Mendelian randomization
cognition
coronary heart disease
education
stroke
0104 Statistics
1117 Public Health and Health Services
Epidemiology
Publication Status
Published
Date Publish Online
2019-09-28