Lower Education Level Tied to Heart Risk

NEW YORK (Reuters Health) - People with less education may be slower to recover a normal heart rate after exerting themselves--a potential health threat researchers say could be related to the greater lifetime stress associated with lower education levels.

In a study of more than 5,200 healthy adults, researchers found that those with who did not graduate from high school were about twice as likely as those with at least some college education to show abnormal heart rate recovery after exercise testing.

Heart rate recovery was gauged by how much the heartbeat had slowed 2 minutes after the participant stopped exercising. A heart rate that is slow to recover from exercise is considered a risk factor for death, and is believed to reflect a problem with the nervous system's response to stress, according to the authors of the new study.

It's possible, they speculate, that people with less education may be more likely to have this nervous-system imbalance, which itself could be related to chronic stress and depression.

However, this study cannot pin down a direct relationship between lower education levels and abnormal heart rate recovery, Dr. Michael S. Lauer and his colleagues point out in the December issue of the American Journal of Medicine.

In the study, Lauer, of the Cleveland Clinic Foundation in Ohio, and his team looked at data on healthy adults from the US and Canada who took part in a study begun in the 1970s. All underwent exercise testing and were followed for an average of 12 years.

Among participants with no high school diploma, half showed an abnormal heart rate recovery, compared with 28% of those with at least some college. The problem was found in about one third of those who finished high school but had no further education.

And after the researchers weighed health factors like age, race, high blood pressure, smoking and exercise habits, the lack of a high school diploma was still tied to a two-fold higher risk of abnormal heart rate recovery.

Over 12 years, 9% of participants who had not finished high school had died, compared with 6% of those who at least completed high school.

According to Lauer's team, research suggests that people with less education may have both more chronic stress and fewer effective ways to cope with it. Sustained stress, in turn, may promote an imbalance in the autonomic nervous system that governs vital bodily functions including heart rate and blood pressure.

SOURCE: American Journal of Medicine 2002;113:643-649.

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