Cardiovascular risk factors in relation to educational level in 36 000 men and women in The Netherlands.

The study objective was to describe the associations between socioeconomic status and (concurrence of) cardiovascular risk factors. The Netherlands Monitoring Project on Cardiovascular Risk Factors is a screening project that was carried out from 1987-1991 in three cities. Cross-sectional data were obtained on educational level and on the prevalence of smoking, alcohol intake, physical inactivity, obesity, hypertension, hypercholesterolaemia and low HDL-cholesterol. A total of 36 000 men and women, aged 20-59 years participated. For all risk factors, except alcohol intake, a significant inverse association was found with educational level. Concurrence of risk factors was more prevalent in lower educated groups than in higher educated groups, but not more than can be expected under the condition of independence of the risk factors (no clustering). In conclusion, in the lower educated groups the prevalence of individual risk factors and of concurrence of risk factors was higher than in the higher educated groups. Concurrence of risk factors can have a synergistic effect on the risk for cardiovascular disease. Therefore socioeconomic differences in risk factors may explain a greater part of the socioeconomic differences in cardiovascular morbidity and mortality than is generally assumed.