MedicalResearch.com Interview with:
Dr. Julien Vaucher
Physician and clinical research fellow (joint first author)
Department of Internal Medicine
Lausanne University Hospital
MedicalResearch.com: What is the background for this study?
Response: Since the sixties, traditional studies have found that people who stay longer in the educational system subsequently develop less coronary heart disease. However, whether this association is causal is not clear, partly because randomised controlled trials are practically infeasible in this area. In our study, we used a genetic approach, called Mendelian randomization, that represents the next best thing to do.Based on genetic variants randomized by nature, we were able to randomize individuals according to 162 genetic markers that associate with more or less education. In other words, we used genetic markers, free from condounding factors, as proxies of education to reproduce the conditions of a trial. Then, if the genetic markers also associate together with coronary heart disease, the association between education and coronary heart disease is likely to be causal.
MedicalResearch.com: What are the main findings?
Response: Using this approach, we found support for the hypothesis that longer education is causally associated with a reduced risk of coronary heart disease. Specifically, 3.6 years of additional schooling (similar to an undergraduate university degree) translated into a 33% reduction in risk of coronary heart disease. Potential mechanisms could include smoking, body mass index, and blood lipids. Our results were robust to multiple sensitivity analyses.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Increasing the number of years that people spend in the educational system may lower their risk of subsequently developing coronary heart disease by a substantial degree. These findings should stimulate policy discussions about increasing educational attainment in the general population to improve population health.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: As mentioned in the discussion, the main question for future research is “What mechanisms account for the strong association seen between genetic predisposition towards longer education and substantially lower risk of CHD?”. More molecular research is thus needed to understand the mechanisms through which these 162 education genetic markers associate with cardiac outcomes. From a public health perspective, any attempt to increase schooling should be closely monitored to capture health benefits.
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BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3542 (Published 30 August 2017)Cite this as: BMJ 2017;358:j3542
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