Abstract 15492: The Prognostic Role of Education Attainment Level in Individuals With Ischemic Heart Disease: Analysis From the Endocrine Vascular Approach Study

Abstract

Introduction: Although adverse outcomes from cardiovascular disease (CVD) have been on a linear decline, the burden remains high. Addressing the social determinants of health in the care of CVD patients is emerging as a strategy for improving outcomes. Educational attainment level (EAL), a proxy of socioeconomic status, has been associated with both cardiovascular risk and patient’s ability to self-manage the complex cardiovascular treatment. Objective: To assess the impact of EAL on major adverse cardiovascular events (MACE) and all-cause death in patients with ischemic heart disease (IHD). Methods: Endocrine Vascular disease Approach (EVA) is a prospective observational study recruiting hospitalized patients with IHD undergoing coronary angiography and/or percutaneous coronary interventions. Socio-demographics and clinical data, including the level of multimorbidity defined by a Charlson Comorbidity Index≥ 4, were collected. A low-EAL, assessed through a self-reported questionnaire, was defined if at least elementary/middle school education was completed. The primary outcome was the occurrence of MACE (i.e. cardiovascular death, non-fatal myocardial infarction, non-fatal stroke) and a secondary composite endpoint (i.e. all-cause death, non-fatal myocardial infarction, non-fatal stroke) was also analyzed. Results: Among 460 individuals (mean age 67±11, 30% women) with IHD, 252 (55%) had a low-EAL. Individuals with low-EAL were younger and more likely to have heart failure, vascular encephalopathy, and high multimorbidity. A low-EAL was associated with a higher risk of MACE compared with higher EAL (Log-rank=12.29, p<0.001) with similar results for the secondary outcome (Log-rank=9.45, p=0.002). In the adjusted multivariate regression analysis, low EAL was independently associated with MACE [Hazard Ration (HR): 2.31, 95% Confidence Interval (CI): 1.23-4.34, p=0.010] and secondary outcome [HR: 1.73, 95%CI 1.02-2.92, p=0.042] compared to high-EAL. Conclusion: Individuals with IHD and low-EAL had a higher risk of MACE and all-cause death. Interventions that specifically address health literacy and cognition should be tested among these high-risk patients to improve outcomes.