Risk factors for coronary heart disease and level of education. The Tromsø Heart Study

The relation between level of education, lifestyle variables, and major risk factors for coronary heart disease were analyzed in 12,368 men and women in Tromsø, Norway. Subjects with the highest education tended to be less overweight, smoke less, be more physically active in leisure time, and have food habits assumed to be less atherogenic (i.e., drink less coffee, use soft margarine and low-fat milk, and eat fruits and vegetables daily) than persons with low education. In men and women, mean serum total cholesterol and systolic blood pressure were negatively associated with educational level, while high density lipoprotein (HDL) cholesterol was positively associated with this variable in women only. The differences between the extreme groups of education (less than 8 and greater than 16 years of education) were as follows: 0.52 mmol/liter (20 mg/100 ml) for serum total cholesterol; 0.03 and 0.14 mmol/liter (1 and 5 mg/100 ml) in men and women, respectively, for HDL cholesterol; and 1.9 and 5.6 mmHg in men and women, respectively, for systolic blood pressure. Adjustment of the relations between level of education and serum total cholesterol and systolic blood pressure for several variables (including food habits) reduced the strength of the associations, which, however, were still statistically significant. For HDL cholesterol, a negative association was found in men when adjustments were done, and the positive association originally observed in women disappeared.