Relation Between Educational Attainment and Cerebral Small Vessel Disease: the Framingham Heart Study

Abstract Background Socioeconomic factors have an impact on long‐term neurovascular health. Education attainment (EA) is a socioeconomic factor which may be related to vascular risk factors and brain health. We investigated the relation of EA and cerebral small vessel disease (CSVD) in community dwelling participants free of stroke and dementia. Method We evaluated 3367 Framingham Heart Study Original and Offspring Cohort participants, categorizing EA into four levels (less than high school, high school graduate, some college, or more). CSVD was assessed via MRI, considering covert infarcts, cerebral microbleeds, cortical superficial siderosis, high perivascular space burden, and extensive white matter hyperintensities, with 1 point assigned for each, to categorize CSVD scores as 0, 1, or 2+. We related education level to the CSVD score using logistic regression analysis with a generalized logits model adjusted for age, sex, and cohort. Result Participants without high school degrees had higher CSVD scores (23% had CSVD score 2+ vs 7% in college graduates) and a higher proportion of hypertension and diabetes. There were slightly higher odds of CSVD scores 2+ in those without high school degrees (OR 1.30, 95% CI 0.62 ‐ 2.73 vs. OR 0.81, 95% CI 0.59‐1.12 in participants with some college or more), but not statistically significant after multivariable adjusted analyses. There was a non‐statistically significant suggestion of higher odds of CSVD 2+ among participants with low EA with APOE‐𝜺4 alleles (OR 2.88, 95% CI 0.57‐14.45). Conclusion Our findings suggest that lower EA may be linked to CSVD burden, but analyses were limited by a small sample of participants with highest CSVD burden and low EA. Further studies are needed to characterize the role of education, a modifiable risk factor, on vascular brain injury.