Lower education level tied to heart failure risk

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NEW YORK: The less education people have, the greater their risk of eventually developing chronic heart failure, a large new study finds.

Researchers say lower education levels are basically a stand-in for people's overall economic condition, and that their findings add to evidence connecting poverty to heart disease.

The results, they add, also suggest that heart failure prevention for lower income people needs to begin early in life.

Heart failure is a chronic condition in which the heart can no longer pump efficiently enough to meet the body's demands, causing symptoms like fatigue, breathlessness and fluid buildup in the limbs.

Coronary heart disease (blockages in the heart arteries) is the underlying cause of about half of heart failure cases. Other major causes include damage to the heart from uncontrolled high blood pressure or diabetes.

A number of studies have found that people with lower incomes and less education have higher rates of coronary heart disease. But little has been known about their risk for heart failure.

The new study, which followed more than 18,600 Danish adults for two decades, found that those with the most education -- more than 10 years of schooling -- were 39 percent less likely to be admitted to a hospital for chronic heart failure than those with the least education, defined as fewer than eight years.

Men and women whose education levels were in between also fell in between when it came to heart failure risk. They were 25 percent less likely than less-educated counterparts to be hospitalized for the condition.

The findings, published in the European Heart Journal, do not prove that lower education, itself, is the reason for the elevated risks.

However, the researchers did account for a number of lifestyle-related factors -- like participants' weight, smoking habits, cholesterol levels and exercise levels -- and found that there was still a link between education and heart failure hospitalizations.

That, they say, suggests lifestyle does not fully explain the gap between the less- and more-educated.

One possibility, according to the researchers, is that people with less education and lower incomes are less likely to get early, aggressive treatment of heart failure or its risk factors, like high blood pressure and diabetes.

Early treatment of those conditions -- or preventing them altogether through a healthy lifestyle -- is key, said senior researcher Dr. Eva Prescott of Bispebjerg University Hospital in Denmark in an e-mail.

Unfortunately, Prescott pointed out, there is a growing social divide worldwide in the very health problems that contribute to heart disease in general, including obesity, diabetes and smoking.

So it will be necessary to head off those problems in young people in order to ultimately narrow the social gap in heart failure.

The findings are based on 18,616 initially heart-disease-free Copenhagen adults followed since 1976. Over 21 years, 2,190 were hospitalized for heart failure.

Of participants with the least education, 18 percent of men and 15 percent of women were hospitalized for heart failure. Those figures were 13 percent and 6 percent, respectively, among participants with the most education.

Prescott said more research is needed to weed out the precise reasons that less-educated men and women are at greater risk of ending up in the hospital with heart failure.

For now, she said, people need to be aware that heart failure is a preventable condition and the risk can be reduced by not smoking, eating a healthy diet, getting regular exercise and maintaining a normal weight.