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Education and coronary heart disease: a Mendelian randomization study

View ORCID ProfileTaavi Tillmann, Julien Vaucher, Aysu Okbay, Hynek Pikhart, Anne Peasey, Ruzena Kubinova, Andrzej Pajak, Abdonas Tamosiunas, Sofia Malyutina, Krista Fischer, Giovanni Veronesi, Tom Palmer, Jack Bowden, George Davey Smith, Martin Bobak, Michael V Holmes
doi: https://doi.org/10.1101/106237
Taavi Tillmann
1Department of Epidemiology & Public Health, University College London, UK
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  • For correspondence: t.tillmann@ucl.ac.uk julien.vaucher@chuv.ch
Julien Vaucher
2Department of Internal Medicine, Lausanne University Hospital, Switzerland
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  • For correspondence: t.tillmann@ucl.ac.uk julien.vaucher@chuv.ch
Aysu Okbay
3Department of Applied Economics, Erasmus University, Netherlands
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Hynek Pikhart
1Department of Epidemiology & Public Health, University College London, UK
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Anne Peasey
1Department of Epidemiology & Public Health, University College London, UK
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Ruzena Kubinova
4Department of Environmental Health Monitoring System, National Institute of Public Health, Prague, Czech Republic
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Andrzej Pajak
5Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University, Krakow, Poland
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Abdonas Tamosiunas
6Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Sofia Malyutina
7Institute of Internal and Preventive Medicine, Novosibirsk, Russia
8Novosibirsk State Medical University, Novosibirsk, Russia
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Krista Fischer
9Estonian Genome Center, University of Tartu, Estonia
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Giovanni Veronesi
10Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
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Tom Palmer
11Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
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Jack Bowden
12Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
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George Davey Smith
12Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
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Martin Bobak
1Department of Epidemiology & Public Health, University College London, UK
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Michael V Holmes
13Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
14Medical Research Council Population Health Research Unit at the University of Oxford, UK
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Abstract

Objectives To determine whether educational attainment is a causal risk factor in the development of coronary heart disease.

Design Mendelian randomization study, where genetic data are used as proxies for education, in order to minimize confounding. A two-sample design was applied, where summary level genetic data was analysed from two publically available consortia.

Setting In the main analysis, we analysed genetic data from two large consortia (CARDIoGRAM and SSGAC), comprising of 112 cohorts from predominantly high-income countries. In addition, we also analysed genetic data from 7 additional large consortia, in order to identify putative causal mediators.

Participants The main analysis was of 589 377 men and women, predominantly of European origin.

Exposure A one standard deviation increase in the genetic predisposition towards higher education (i.e. 3.6 years of additional schooling). This was measured by 162 genetic variants that have been previously associated with education.

Main outcome Combined fatal and nonfatal coronary heart disease (63 746 events).

Results 3.6 years of additional education lowered the risk of coronary heart disease by a third (odds ratio = 0.67, 95% confidence interval [CI], 0.59 to 0.77, p=0.01). Equivalent increases in education were also causally associated with reductions in smoking, BMI and improvements in blood lipid profiles.

Conclusions More time spent in education is causally associated with a large reduction in the risk of coronary heart disease. This may be partly explained by changes to smoking, BMI and a blood lipids. These findings offer support for policy interventions that increase education, in order to also reduce the burden of cardiovascular disease.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license.
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Posted February 06, 2017.
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Education and coronary heart disease: a Mendelian randomization study
Taavi Tillmann, Julien Vaucher, Aysu Okbay, Hynek Pikhart, Anne Peasey, Ruzena Kubinova, Andrzej Pajak, Abdonas Tamosiunas, Sofia Malyutina, Krista Fischer, Giovanni Veronesi, Tom Palmer, Jack Bowden, George Davey Smith, Martin Bobak, Michael V Holmes
bioRxiv 106237; doi: https://doi.org/10.1101/106237
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Education and coronary heart disease: a Mendelian randomization study
Taavi Tillmann, Julien Vaucher, Aysu Okbay, Hynek Pikhart, Anne Peasey, Ruzena Kubinova, Andrzej Pajak, Abdonas Tamosiunas, Sofia Malyutina, Krista Fischer, Giovanni Veronesi, Tom Palmer, Jack Bowden, George Davey Smith, Martin Bobak, Michael V Holmes
bioRxiv 106237; doi: https://doi.org/10.1101/106237

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