Observational studyBMJ (Clinical research ed.)2019
Understanding the consequences of education inequality on cardiovascular disease: mendelian randomisation study.
Observational study in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 181 papers, 10 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
181 citing papers in PubMed, 10 syntheses or guidelines pooled it, 333 citations in OpenAlex.
- Socioeconomic position, genetic susceptibility, and epigenetic profiles in obesity across the life course: a systematic review.International journal of obesity (2005) · 2026Pooled it
- A systematic review of causal pathways of socioeconomic inequalities in stroke.International journal of stroke : official journal of the International Stroke Society · 2026Pooled it
- Strengthening the reporting of observational studies in epidemiology using Mendelian randomization (STROBE-MR): a Korean translation of explanation and elaboration.Ewha medical journal · 2025Guideline
- Pooled it
- Appraising the Causal Role of Risk Factors in Coronary Artery Disease and Stroke: A Systematic Review of Mendelian Randomization Studies.Journal of the American Heart Association · 2023Pooled it
- Independent Associations of Education, Intelligence, and Cognition With Hypertension and the Mediating Effects of Cardiometabolic Risk Factors: A Mendelian Randomization Study.Hypertension (Dallas, Tex. : 1979) · 2023Pooled it
- Educational attainment in patients with congenital heart disease: a comprehensive systematic review and meta-analysis.BMC cardiovascular disorders · 2021Pooled it
- Using Mendelian randomization analysis to better understand the relationship between mental health and substance use: a systematic review.Psychological medicine · 2021Pooled it
- Genetically predicted education attainment in relation to somatic and mental health.Scientific reports · 2021Pooled it
- Urate, Blood Pressure, and Cardiovascular Disease: Evidence From Mendelian Randomization and Meta-Analysis of Clinical Trials.Hypertension (Dallas, Tex. : 1979) · 2021Pooled it
- Can increasing years of schooling reduce type 2 diabetes (T2D)?: Evidence from a Mendelian randomization of T2D and 10 of its risk factors.Scientific reports · 2020Trial
- Causal links between gut microbiota, plasma metabolites, and insomnia: Insights from Mendelian randomization.Dialogues in clinical neuroscience · 2026Article
- Elucidating the proteomic pathways linking childhood body mass index with type 2 diabetes: a Mendelian randomization and recall-by-genotype study.International journal of epidemiology · 2026Article
- Metabolites stratify future major depressive disorder risk in obese population: a longitudinal machine learning analysis.Psychological medicine · 2026Article
- Triglyceride-glucose index, plasma metabolome and aortic stenosis: a Mendelian randomization analysis.Journal of cardiothoracic surgery · 2026Article
- Gut Microbiome Mediates the Causal Link Between Autism Spectrum Disorder and Dietary Preferences: A Mendelian Randomization Study.International journal of molecular sciences · 2026Article
- Iron status modulates immune cell proportions to drive epigenetic age acceleration: A 2-step Mendelian randomization study.Medicine · 2026Article
- Machine learning performance for a small dataset: random oversampling improves data imbalances and fairness.BMC medical research methodology · 2026Article
- The Association Between Irritable Bowel Syndrome and Generalized Anxiety Disorder and Influencing Factors: A Mediation Mendelian Randomization Study.Food science & nutrition · 2026Article
- Association Between Educational Attainment and the Risk of Gynecological Malignancies: A Mediation Mendelian Randomization Study.International journal of women's health · 2026Article
121 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors at 11 institutions in 5 countries.
Funding
Abstract
objectivesTo investigate the role of body mass index (BMI), systolic blood pressure, and smoking behaviour in explaining the effect of education on the risk of cardiovascular disease outcomes.
designMendelian randomisation study.
settingUK Biobank and international genome-wide association study data.
participantsPredominantly participants of European ancestry. EXPOSURE: Educational attainment, BMI, systolic blood pressure, and smoking behaviour in observational analysis, and randomly allocated genetic variants to instrument these traits in mendelian randomisation. MAIN OUTCOMES MEASURE: The risk of coronary heart disease, stroke, myocardial infarction, and cardiovascular disease (all subtypes; all measured in odds ratio), and the degree to which this is mediated through BMI, systolic blood pressure, and smoking behaviour respectively.
resultsEach additional standard deviation of education (3.6 years) was associated with a 13% lower risk of coronary heart disease (odds ratio 0.86, 95% confidence interval 0.84 to 0.89) in observational analysis and a 37% lower risk (0.63, 0.60 to 0.67) in mendelian randomisation analysis. As a proportion of the total risk reduction, BMI was estimated to mediate 15% (95% confidence interval 13% to 17%) and 18% (14% to 23%) in the observational and mendelian randomisation estimates, respectively. Corresponding estimates were 11% (9% to 13%) and 21% (15% to 27%) for systolic blood pressure and 19% (15% to 22%) and 34% (17% to 50%) for smoking behaviour. All three risk factors combined were estimated to mediate 42% (36% to 48%) and 36% (5% to 68%) of the effect of education on coronary heart disease in observational and mendelian randomisation analyses, respectively. Similar results were obtained when investigating the risk of stroke, myocardial infarction, and cardiovascular disease.
conclusionsBMI, systolic blood pressure, and smoking behaviour mediate a substantial proportion of the protective effect of education on the risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of cardiovascular disease attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.