The Impact of Educational Status on 10-Year (2004-2014) Cardiovascular Disease Prognosis and All-cause Mortality Among Acute Coronary Syndrome Patients in the Greek Acute Coronary Syndrome (GREECS) Longitudinal Study.
OBJECTIVES
The association between educational status and 10-year risk for acute coronary syndrome (ACS) and all-cause mortality was evaluated.


METHODS
From October 2003 to September 2004, 2172 consecutive ACS patients from six Greek hospitals were enrolled. In 2013 to 2014, a 10-year follow-up (2004-2014) assessment was performed for 1918 participants (participation rate, 88%). Each patient's educational status was classified as low (<9 years of school), intermediate (9 to 14 years), or high (>14 years).


RESULTS
Overall all-cause mortality was almost twofold higher in the low-education group than in the intermediate-education and high-education groups (40% vs. 22% and 19%, respectively, p<0.001). Additionally, 10-year recurrent ACS events (fatal and non-fatal) were more common in the low-education group than in the intermediate-education and high-education groups (42% vs. 30% and 35%, p<0.001), and no interactions between sex and education on the investigated outcomes were observed. Moreover, patients in the high-education group were more physically active, had a better financial status, and were less likely to have hypertension, diabetes, or ACS than the participants with the least education (p<0.001); however, when those characteristics and lifestyle habits were accounted for, no moderating effects regarding the relationship of educational status with all-cause mortality and ACS events were observed.


CONCLUSIONS
A U-shaped association may be proposed for the relationship between ACS prognosis and educational status, with participants in the low-education and high-education groups being negatively affected by other factors (e.g., job stress, depression, or loneliness). Public health policies should be aimed at specific social groups to reduce the overall burden of cardiovascular disease morbidity.
['Notara|Venetia|V|', 'Panagiotakos|Demosthenes B|DB|', 'Kogias|Yannis|Y|', 'Stravopodis|Petros|P|', 'Antonoulas|Antonis|A|', 'Zombolos|Spyros|S|', 'Mantas|Yannis|Y|', 'Pitsavos|Christos|C|']
D054058:Acute Coronary Syndrome D000368:Aged D000369:Aged, 80 and over D002318:Cardiovascular Diseases D002423:Cause of Death D003710:Demography D003920:Diabetes Mellitus D004522:Educational Status D015444:Exercise D005260:Female D005500:Follow-Up Studies D006115:Greece D017052:Hospital Mortality D006761:Hospitals D006801:Humans D006973:Hypertension D008019:Life Style D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D011379:Prognosis D012008:Recurrence D012307:Risk Factors D012923:Social Class D015996:Survival Rate
Cardiovascular disease Acute coronary syndrome Educational staus Risk factors Social class Unhealthy behaviors