Does being a doctor give you an edge on heart health?

By Liz Meszaros, MDLinx
Published July 16, 2019

Key Takeaways

It is no secret that physicians have the most rigorous educational requirements of any profession. With the typical curriculum of 4 years of undergraduate schooling, 4 years of medical school, and 3-7 years of residency training before they are eligible for a medical license (not to mention lifelong CME requirements), doctors stay in school longer than anyone else.

But—besides eliciting groans and incredible investments of time, money, and brain power—the long years of schooling needed to practice medicine may have an upside.

Researchers have recently found that increased education is associated with improvements in cardiovascular disease (CVD) risk factors such as smoking, depression, triglycerides, and high-density lipoproteins (HDLs). They have published their results in PLoS Medicine.  One of the downsides, however, is that increased education may also be associated with increased BMI and total cholesterol.

Importance of education

Previous research suggests that, to improve the accuracy of clinical predictive models, like the Framingham risk score, a gender-specific algorithm used to estimate 10-year cardiovascular risks, as well as clinical decision-making, a person’s educational attainment should be factored in.

Both the 2019 guidelines from the American College of Cardiology and the American Heart Association and experts from the US Department of Health and Human Services have suggested that a patient’s social characteristics be included in clinical prediction tools and that physician panels be risk-adjusted to determine payments to physicians for their performance.

“There are numerous hypothesized pathways linking education with CVD. Increased educational duration, quality, and credentials are thought to increase employment; augment psychosocial resources such as literacy, social capital, and decision-making; and improve health behaviors like smoking. Psychosocial resources and employment, in turn, may increase income and decrease stress. Each of these may then lead to reduced CVD,” wrote the authors, led by Rita Hamad, MD, PhD, assistant professor, Family Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA.

What they found

For their analysis, Dr. Hamad and colleagues linked census data on educational attainment in childhood from about 5.4 million Americans with health outcomes in adulthood from the 1992-2012 Health and Retirement Study (HRS; N=30,853 and serial cross-sectional data from 1971-2012 National Health and Nutrition Examination Survey (NHANES; N=44,732).

Specifically, they looked at self-reported CVD outcomes, related risk factors, and relevant serum biomarkers.

In all, 34.5% of study participants reported CVD. Researchers found that each year of additional compulsory schooling through high school was associated with a 2.5% reduction in the occurrence of CVD. In addition, they found improvements in CVD risk factors with each additional year of schooling, which included a reduction of more than 3% in smoking, and almost 5% in depression.

Using an instrumental variables analysis, Dr. Hamad and colleagues found that an increased education was associated with the following reductions:

  • Smoking (HRS ß: -0.036; 95% CI: -0.06 to -0.02; P <01; NHANES ß: -0.032; 95% CI: -0.05 to -0.02; P < 0.01)
  • Depression (HRS β: −0.049; 95% CI: −0.07 to −0.03; P < 0.01)
  • Triglycerides (NHANES β: −0.039; 95% CI: −0.06 to −0.01; P < 0.01), and
  • Heart disease (HRS β: −0.025; 95% CI: −0.04 to −0.002; P=0.01)

In addition, increased educational attainment was associated with improvement in HDL cholesterol (HRS β: 1.50, 95% CI: 0.34 to 2.49, P < 0.01; NHANES β: 0.86; 95% CI: 0.32 to 1.48; P < 0.01).

However, additional schooling was also associated with increases in both BMI (HRS β: 0.20, 95% CI: 0.002 to 0.40; P=0.05; NHANES β: 0.13; 95% CI: 0.01 to 0.32, P=0.05) and total cholesterol (HRS β: 2.73; 95% CI: 0.09 to 4.97, P=0.03).

One explanation for this finding is that high-income individuals born during this timeframe had a tendency to eat richer diets.

But, overall, the results were positive—more schooling had a positive association with reductions in CVD risk factors.

“Our findings support the established associations between education and reduced smoking, depression, and heart disease and improved HDL, suggesting that both health behaviors and stress are important mechanisms. Our study thereby contributes new knowledge on potential pathways through which education may influence CVD, and it adds to the evidence supporting broader implementation of interventions to target this key social determinant of health,” concluded Dr. Hamad and colleagues.

Take heart, therefore, that all those years of schooling are doing more than advancing your career—they may be contributing to your good health as well.

This study was funded by the National Institutes of Health and a grant from the American Educational Research Association.

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