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• W2121656970 abstract "HomeCirculationVol. 123, No. 20Response to Letter Regarding Article, “Attained Educational Level and Incident Atherothrombotic Events in Low- and Middle-Income Compared With High-Income Countries” Free AccessReplyPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReplyPDF/EPUBResponse to Letter Regarding Article, “Attained Educational Level and Incident Atherothrombotic Events in Low- and Middle-Income Compared With High-Income Countries” Abhinav Goyal, MD, MHS Deepak L. Bhatt, MD, MPH P. Gabriel Steg, MD Bernard J. Gersh, MD Mark J. Alberts, MD E. Magnus Ohman, MD and Robert M. Califf, MD Ramón Corbalán, MD Kim A. Eagle, MD Efrain Gaxiola, MD Runlin Gao, MD Shinya Goto, MD, PhD Ralph B. D'Agostino, PhD Sidney C. SmithJr, MD Peter W.F. Wilson, MD Abhinav GoyalAbhinav Goyal Emory Rollins School of Public Health Atlanta, GA (Goyal) Search for more papers by this author Deepak L. BhattDeepak L. Bhatt VA Boston Healthcare System Brigham and Women's Hospital and Harvard Medical School Boston, MA (Bhatt) Search for more papers by this author P. Gabriel StegP. Gabriel Steg INSERM U-698 Universite' Paris 7 Paris, France (Steg) Search for more papers by this author Bernard J. GershBernard J. Gersh Division of Cardiovascular Diseases and Internal Medicine Mayo Clinic Rochester, MN (Gersh) Search for more papers by this author Mark J. AlbertsMark J. Alberts Northwestern University Feinberg School of Medicine Chicago, IL (Alberts) Search for more papers by this author E. Magnus OhmanE. Magnus Ohman Duke Clinical Research Institute Durham, NC (Ohman, Califf) Search for more papers by this author and Robert M. CaliffRobert M. Califf Duke Clinical Research Institute Durham, NC (Ohman, Califf) Search for more papers by this author Ramón CorbalánRamón Corbalán Pontificia Universidad Católica Santiago, Chile (Corbalán) Search for more papers by this author Kim A. EagleKim A. Eagle University of Michigan Medical Center Ann Arbor, MI (Eagle) Search for more papers by this author Efrain GaxiolaEfrain Gaxiola Centro Especializado en Terapia Endovascular Jardínes Hospital de Especialidades Guadalajara, Mexico (Gaxiola) Search for more papers by this author Runlin GaoRunlin Gao Fuwai Hospital Beijing, China (Gao) Search for more papers by this author Shinya GotoShinya Goto Tokai University School of Medicine Kanagawa, Japan (Goto) Search for more papers by this author Ralph B. D'AgostinoRalph B. D'Agostino Boston University Boston, MA (D'Agostino) Search for more papers by this author Sidney C. SmithJrSidney C. SmithJr UNC Center for Cardiovascular Science and Medicine University of North Carolina-Chapel Hill Chapel Hill, NC (Smith) Search for more papers by this author Peter W.F. WilsonPeter W.F. Wilson Emory School of Medicine Atlanta, GA (Wilson) Search for more papers by this author Originally published24 May 2011https://doi.org/10.1161/CIRCULATIONAHA.111.025189Circulation. 2011;123:e606We thank Dr Nabi for his comments regarding our publication that related attained educational level to cardiovascular disease outcomes in the REduction of Atherothrombosis for Continued Health (REACH) Registry experience.1 Dr Nabi correctly interprets Table 3 of our report, which indicates that in women from low- and middle-income countries (LMICs), there was no gradient in the rate of cardiovascular events across education groups. We believe that these data are fairly interpreted by our statement, “higher AEL may not be protective against cardiovascular events in LMICs, particularly in women.” Dr Nabi also questions our suggestion that the promotion of education in women in LMICs may be insufficient to reduce their cardiovascular risk, and that other interventions may be necessary, such as ensuring that women of all educational backgrounds have adequate access to health care. We agree that this area requires further study, and we hope that our findings are investigated more fully in other analyses in the future. We believe that the most important conclusion of our work is that studies conducted in high-income countries that link socioeconomic status (including educational attainment) to cardiovascular outcomes cannot be extrapolated to LMIC settings. It is essential to conduct separate studies in LMIC settings, which bear most of the global burden of cardiovascular disease.Abhinav Goyal, MD, MHS Emory Rollins School of Public Health Atlanta, GADeepak L. Bhatt, MD, MPH VA Boston Healthcare System Brigham and Women's Hospital and Harvard Medical School Boston, MAP. Gabriel Steg, MD INSERM U-698 Universite' Paris 7 Paris, FranceBernard J. Gersh, MD Division of Cardiovascular Diseases and Internal Medicine Mayo Clinic Rochester, MNMark J. Alberts, MD Northwestern University Feinberg School of Medicine Chicago, ILE. Magnus Ohman, MDRobert M. Califf, MD Duke Clinical Research Institute Durham, NCRamón Corbalán, MD Pontificia Universidad Católica Santiago, ChileKim A. Eagle, MD University of Michigan Medical Center Ann Arbor, MIEfrain Gaxiola, MD Centro Especializado en Terapia Endovascular Jardínes Hospital de Especialidades Guadalajara, MexicoRunlin Gao, MD Fuwai Hospital Beijing, ChinaShinya Goto, MD, PhD Tokai University School of Medicine Kanagawa, JapanRalph B. D'Agostino, PhD Boston University Boston, MA (D'Agostino)Sidney C. Smith, Jr, MD UNC Center for Cardiovascular Science and Medicine University of North Carolina-Chapel Hill Chapel Hill, NCPeter W.F. Wilson, MD Emory School of Medicine Atlanta, GADisclosuresDr Bhatt reports receiving research support from Astra Zeneca, Bristol-Myers Squibb, Eisai, Ethicon, Heartscape, Sanofi-aventis, and The Medicines Company. Dr Steg reports receiving research support from Servier; fees for speaking or consulting from Astellas, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS, Daiichi-Sankyo-Lilly, GSK, Menarini, Medtronic, Otsuka, Pierre Fabre, Roche, Sanofi-aventis, Servier, and The Medicines Company; and holding stock in Aterovax. The remaining authors report no conflicts.Reference1. Goyal A, Bhatt DL, Steg G, Gersh BJ, Alberts MJ, Ohman M, Corbalán R, Eagle KA, Gaxiola E, Gao R, Goto S, D'Agostino RB, Califf RM, Smith SC, Wilson PWF. Attained educational level and incident atherothrombotic events in low- and middle-income compared with high-income countries. Circulation. 2010; 122: 1167–1175.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails May 24, 2011Vol 123, Issue 20 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.111.025189 Originally publishedMay 24, 2011 PDF download Advertisement SubjectsEpidemiology" @default.
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