Lifestyle and Cardiovascular Risk Factors by Educational Attainment in a Mediterranean Setting: A Cross-Sectional Analysis of a Population-Based Sample

Abstract

Background: Socioeconomic inequalities in cardiovascular risk persist despite declining mortality. We examined the prevalence of cardiovascular risk factors and lifestyle behaviors across educational levels in men and women from a Mediterranean population.

Methods: Cross-sectional analysis of adults aged 35–74 years from a population-based sample in north-eastern Spain. Risk factors and lifestyle were assessed with standardized measurements and validated questionnaires. Educational attainment was categorized as primary, secondary, or university. Analyses were sex-stratified; age-adjusted linear and logistic regression models were applied.

Results: We included 943 adults (52.3% women). Among men, secondary and university education (vs. primary) were associated with lower LDL-cholesterol [β –11.76 (95% CI –21.68 to –1.83) and –17.83 (–28.03 to –7.63) mg/dL], lower odds of hypercholesterolemia [OR = 0.43 (0.20–0.90) for both], smoking [OR = 0.57 (0.33–0.97) and 0.53 (0.30–0.95)], and higher odds of high Mediterranean diet adherence [OR = 2.08 (1.04–4.16) and 3.05 (1.51–6.14)]. Among women, secondary and university education (vs. primary) were associated with lower body mass index [β –1.81 (–2.85 to –0.77) and –2.52 (–3.63 to –1.40) kg/m2] and lower odds of overweight/obesity [OR = 0.47 (0.29–0.76) and 0.34 (0.20–0.56)]. Lower odds of hypertension [OR = 0.44 (0.22–0.87)] and high Mediterranean diet adherence [OR = 2.14 (1.12–4.09)] were also more likely in university-educated women.

Conclusions: Higher educational attainment was associated with healthier lifestyles and more favorable cardiometabolic profiles. Educational gradients were broader in women—spanning adiposity, blood pressure, glycemia, and lipidemia—whereas, in men, they mainly affected lipidemia and diet.