More education may mean a lower heart attack risk later in life, with benefits seen in low-income countries as well as wealthy nations, a new study finds.

A number of studies in Western countries have found a link between higher socioeconomic status and lower heart disease risk. However, studies measure socioeconomic status in various ways -- by people's education or current job or current family income, for instance -- and it is not clear whether all of those factors are equally important.

In addition, little is known about how socioeconomics affect heart disease risk in developing countries.

For the new study, reported in the journal Heart, researchers analyzed data on more than 12,000 heart attack sufferers and 14,000-plus healthy adults the same age from 52 countries.

They found that across the nations, education -- but not family income, material possessions or persons' occupations -- was strongly connected to heart attack risk. That connection was stronger in the wealthiest countries, but also apparent in middle- and low-income countries.

The stronger association with education is probably due to better knowledge about what causes heart disease and how to avoid these causes, lead researcher Dr. Annika Rosengren, of Sahlgrenska University Hospital in Goteborg, Sweden, told Reuters Health in an email.

In support of that idea, the study found that higher rates of abdominal obesity and poorer lifestyle habits -- including less exercise, more smoking and lower intake of fruits and vegetables -- explained about half of the risk connected to low education levels.

Knowledge of these risk factors, Rosengren said, is a first step toward making healthy choices.

Still, the study found that even with lifestyle, income, age and other factors considered, people with low education levels (defined as eight years of school or less) were 31 percent more likely to suffer a heart attack than those with some education beyond high school.

Across wealthy countries, low education was linked to a 61 percent higher risk of heart attack, while the corresponding figure across low- and middle-income countries was 25 percent.

The findings, according to the researchers, suggest that with economic development and increasing incomes across a nation, the heart-health gap between the well-educated and the less-educated widens.

More research is needed to fully understand the reasons for the education-related disparity. But for now, the findings suggest that expanding education in developing countries could help counter their rising rates of heart disease, according to Rosengren's team.

These findings, they write, suggest that improving education levels has the potential to partially prevent the rising epidemic of (heart disease) in developing countries, as it could lead to healthier lifestyles.

SOURCE: Heart, December 15, 2009.

Medicine