Abstract 4139311: Comparative Effects of Education and Income Levels and Cardiovascular Risk Factors for the Risk of Ischemic Heart Disease, Ischemic Stroke, or Peripheral Artery Disease Associated Mortality

Background: Low educational attainment and income are associated with a higher risk of adverse cardiovascular (cv) outcomes. Research Question: The impact of lower education and income levels on the risk of cv death defined as ischemic heart disease, ischemic stroke, or peripheral artery disease associated mortality, and how this compares to traditional cv risk factors including overweight/obesity, hypertension, type 2 diabetes, smoking history, frequent alcohol consumption, physical activity, and family history for heart disease. Methods: In this prospective study involving 396,614 participants of the United Kingdom Biobank (UKB) with no history of ischemic heart disease, ischemic stroke, or peripheral artery disease at enrollment, we divided participants into five groups according to annual household income as defined in UKB, and six groups of educational attainment created using the International Standard Classification of Education. Five BMI (kg/m 2 ) categories were created (<25; 25-29.9; 30-34.9; 35-39.9, ≥40). The association of education and income with cv death was assessed using Fine-Gray sub-distribution hazard models including covariate adjustment for age, sex, race, number of people in the household, spatial socioeconomic deprivation, plasma lipids, and traditional cv risk factors. Results: Mean age was 55.8 years, 46% were men, and mean time of follow-up was 14.3 years. There were 3,930 cv deaths. One level lower in income was associated with a higher risk for cv death (aHR 1.28, 95% CI 1.22-1.34, p <0.0001). One level lower in education was non-significantly associated with cv death (aHR 1.02, 95% CI 1.00-1.04, p=0.06). One level lower in income was associated with a higher risk for cv death compared to one group higher in BMI categories (aHR 1.15, 95% CI 1.10-1.21, p <0.0001) and was comparable to the risk associated with having a father, mother, or sibling with heart disease. Conclusion: The risk for cv death associated with one level lower in income as assessed in the UKB is higher than the risk associated with one group higher in BMI categories and comparable with a family history for heart disease, highlighting the importance to assess socioeconomic factors in cardiovascular risk assessments.