Heart Study Looks at Education

Monday, August 28th 2000, 12:00 am

By: News On 6

AMSTERDAM (AP) â€” Highly educated people are more likely to be alive a year after suffering a heart attack than those whose schooling ended after 12 years, new research suggests.

While it is known that more educated people and those with higher-status jobs are less likely to get heart disease, to have a heart attack or to die from the disease, experts have not known whether those factors influence how well people survive once they've had a heart attack.

But an international study presented Sunday found that heart attack survivors with higher socioeconomic status and better jobs did better than poorer ones in each of the nine countries examined. The study also found that socioeconomic status mattered more in some countries than others.

The study, presented at the opening of a four-day conference of the European Society of Cardiology, used education as an indicator of socioeconomic status.

In the United States, Australia and Poland, the highly educated didn't have much of an edge, the study said. But in Italy, Sweden and Britain, they were much more likely to make it than those who had left school earlier, the study by scientists at Duke University Medical Center found.

In general, the more educated people were, the better off they were. People who dropped out of school after eight years were five times more likely to die within a year of their heart attack than those who had had 16 years of education.

A number of factors could be to blame, including increased stress, poor understanding of the disease process and not making the necessary lifestyle changes needed to promote a better outcome, said the study's leader, Duke heart researcher Dr. Connor O'Shea.

``It's very interesting that education is affecting prognosis after a heart attack. Everybody had their education long before they got their heart attack, and they all were in the same position when the study started,'' said Dr. Harry Hemmingway, a researcher at University College, London University, who studies psychological and social influences on heart disease.

``Most people only wake up once they've had a heart attack, but there is no conventional wisdom on how socioeconomic status affects heart attack survival because there have been very few studies,'' said Hemmingway, who was not connected to the study.

In the study of 11,326 people from the United States, Canada, Britain, Germany, Australia, New Zealand, Sweden, Poland and Italy, job status â€” considered a reflection of education level â€” also made a difference in surviving after a heart attack.

Managers fared best, followed by craftsmen, then clerical workers, laborers and homemakers. Homemakers were most likely to die within a year of their heart attack â€” four times more likely than managers.

Contrary to other studies, the scientists also found that living alone didn't appear to matter. Those living alone did die sooner after their heart attack than those with company at home, but most of that can be explained by their age, O'Shea said. He said studies that have concluded the opposite were much smaller and did not adjust their findings well enough to eliminate the influence of being older.

``You get older, people around you die and you end up living alone, but living alone in itself is not an independent risk factor'' for dying after a heart attack, he said.

Hemmingway said several of the studies that have found that living alone influences heart attack survival did take age into account. He said the Duke findings on that factor are not definitive, but lend weight to the theory that it doesn't matter.