Low education, smoking, high blood pressure may lead to increased stroke risk

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Adult smokers with limited education face a greater risk of stroke than those with a higher education, according to new research in the American Heart Association’s journal Stroke.

The combination of smoking and high blood pressure increased stroke risk the most, confirming earlier findings in numerous studies.


In a multicentre Danish study, researchers defined lower education as grade school or lower secondary school (maximum of 10 years) education.


“We found it is worse being a current smoker with lower education than a current smoker with a higher education,” says Helene Nordahl, study lead author and researcher at the Department of Public Health at the University of Copenhagen in Denmark. “Targeted interventions aimed at reducing smoking and high blood pressure in lower socioeconomic groups would yield a greater reduction in stroke than targeting the same behaviours in higher socioeconomic groups.”


Researchers divided 68,643 adults (30-70 years old) into low, medium and high education levels and assessed smoking and high blood pressure levels. They found:

  • Sixteen per cent of men and 11% of women were at high-risk of stroke due to low education level, smoking and high blood pressure.
  • Men were more at risk of stroke than women, and the risk of stroke increased with age.
  • Ten per cent of the high-risk men and 9% of the high-risk women had an ischaemic stroke during the study’s 14-year follow-up.
  • Smokers with low education had a greater risk of stroke than smokers with high education regardless of their blood pressure.


“Universal interventions such as legislation or taxation could also have a strong effect on stroke in the most disadvantaged,” Nordahl says. “We need to challenge disparities in unhealthy behaviours, particularly smoking.”


Researchers were not able to consider differences associated with ethnicity because 98% of the participants were Danes.


“The distribution of stroke risk factors may vary across various contexts and study populations,” Nordahl says. “However, since the most disadvantaged groups are often exposed to a wide number of stroke risk factors, it seems plausible that these people are at higher risk of stroke not only in Denmark, but also in other industrialised countries.”


Co-authors are Merete Osler; Birgitte Lidegaard Frederiksen; Ingelise Andersen; Eva Prescott; Kim Overvad; Finn Diderichsen; and Naja Hulvej Rod. Author disclosures are on the manuscript.


The Danish Cancer Society funded the study.