Cardiovascular disease prevention by personalized health promotion considering educational attainment

Abstract

To examine whether educational attainment modifies the effectiveness of personalized lifestyle recommendations for improving cardiovascular risk factors. This post-hoc analysis used data from a population-based randomized controlled trial in Girona, Spain, including adults aged 35-74 years without cardiovascular disease at baseline. Participants (n = 759; 48.7% men) were randomized to an intervention group (n = 380), which received personalized recommendations on diet and physical activity, or a control group (n = 379), which received a standard report of baseline results. Changes in systolic and diastolic blood pressure, LDL cholesterol, and physical activity energy expenditure from baseline to 12 months were analyzed. Multivariable linear regression models adjusted for age included an interaction term defined as group × educational attainment × time (1 year) to assess effect modification. Analyses were stratified by sex. Among women in the intervention group, significant interactions by educational attainment were observed. Compared with women with lower educational attainment, those with higher attainment showed more favorable changes in diastolic blood pressure [beta-coefficient (95% confidence interval): - 1.98 (- 4.23; 0.27) vs. 1.63 (- 0.21; 3.48)], LDL cholesterol [- 4.61 (- 11.40; 2.18) vs. 5.71 (0.25; 11.17)], and physical activity energy expenditure [0.52 (0.04; 1.23) vs. - 0.01 (- 0.36; 0.26)]. No significant interactions were found among men in the intervention group or among participants in the control group. Overall, within-group changes in these outcomes did not reach statistical significance. Personalized lifestyle interventions may provide greater benefits for women with higher educational attainment, although overall improvements were modest.