Educational Attainment and Calculated Risk of Coronary Heart Disease in the Independent State of Samoa: A Cross-Sectional Analysis

Background: Cardiovascular risk factors are increasingly prevalent in the Independent State of Samoa. Research has explored the association between cardiovascular risk factors, genetics, and nutrition, but fewer studies have investigated the role of social determinants of health. Our study assessed the association between cardiovascular risk and education as a proxy for health literacy.

Methods: Cross-sectional surveys, anthropometric, and biological data from the 2010 Samoa Genome-Wide Association Study of Adiposity were analyzed for 1812 Samoan adults without previous cardiovascular disease or diabetes. We assessed odds ratios (OR) and 95%CI for having ≥10% risk of developing coronary heart disease (CHD) in 10 years (based on Framingham risk score) against education, using multiple logistic regression. Post-hoc logistic regression assessed odds of being eligible for LDL-lowering medications (based on Adult Treatment Panel (ATP)-III guidelines) by education level. All analyses were stratified by gender and adjusted for body mass index, occupation, and education-level of household-head.

Results: Participants who completed primary school or less had significantly increased odds of having ≥10% risk of developing CHD in 10 years compared to those with college/graduate education (aOR=4.15, 95%CI 2.04-8.46). Among males, this association remained significant (aOR 3.57, 95%CI 1.58-8.06). Females who completed primary school or less had significantly increased odds of being eligible for LDL-lowering medications, compared to those with college/graduate education (aOR 4.62, 95%CI 2.05-10.41).

Conclusion: Our findings implicate the need for policies to expand the reach of cardiovascular risk factor screenings and medications to Samoans with limited formal education. Future studies should explore structural level barriers to cardiovascular risk prevention.