Sex-Based Associations Between Education Level, EAT-Lancet Diet, and 20-Year Cardiovascular Risk: The ATTICA Study
Evangelia G Sigala1, Christos Pitsavos2, Fotios Barkas3
1Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17671 Athens, Greece.
Nutrients
|September 13, 2025
Summary
Higher education is linked to lower cardiovascular disease (CVD) risk, with sustainable diets playing a mediating role, especially for women. This highlights the need for equitable CVD prevention strategies.
Area of Science:
- Public Health
- Epidemiology
- Nutritional Science
Background:
- Educational attainment is a social determinant of health.
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Understanding socioeconomic factors influencing CVD is crucial for prevention.
Purpose of the Study:
- To examine the association between educational level and 20-year CVD incidence, mortality, lifetime risk, and burden.
- To investigate the mediating effect of healthy and sustainable dietary patterns on this relationship.
- To explore potential sex differences in these associations.
Main Methods:
- Longitudinal analysis of 3042 adults from the ATTICA Study (2001/2002 baseline).
- Assessment of educational attainment, adherence to the EAT-Lancet diet pattern (EAT-LDP), and physical activity.
- Application of generalized structural equation and Cox regression models for 20-year CVD outcome analysis.
Main Results:
- An inverse gradient was observed between education and CVD risk/burden, more pronounced in females for lifetime risk.
- Each additional year of education correlated with higher EAT-LDP adherence and physical activity.
- Dietary habits partially mediated the link between education and long-term CVD incidence, with stronger cardioprotective effects of EAT-LDP in lower educated females.
Conclusions:
- Educational disparities significantly impact long-term cardiovascular health outcomes.
- Sustainable dietary habits are a key mediator in the education-CVD relationship.
- Gender-responsive and equity-focused strategies are essential for effective cardiovascular disease prevention.
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