The attainment of many years of education has been considered a protective factor against cardiovascular events. However, it is not known whether EA has a causative relationship with the occurrence of SVT. The objective of this study was to explore whether there was a causal relationship between education and SVT using MR analysis. We used six distinct estimation methods (IVW, weighted median, simple model, weighted model, MR-Egger regression test and MR-PRESSO) for the MR analyses. The results of the IVW, weighted median analysis and MR-PRESSO methods suggested a negative causative association between EA and SVT. Considering the advantage of the weighted median method compared to the MR-Egger method, all methods above showed a negative trend. Common cardiovascular risk factors did not mediate the association between EA and SVT. Therefore, our study provides supportive evidence of an inverse causative association of years of education with SVT.
The association between education and cardiovascular disease has been reported by several previous studies[23, 25, 26]. Studies have shown that in low-income countries, low education is associated with a higher risk of cardiovascular disease and death than in higher-income countries[25]. A previous MR analysis also demonstrated a negative causal relationship between education and cardiovascular disease[10]. Similar to our results, they identified a negative causal relationship between education and atrial fibrillation[27]. Education influences a variety of conditions from childhood via exposure to community-level factors (such as living or working in a healthier environment) and better access to health and social resources[25]. Our findings support that the completion of more years of education is related to a reduced risk of SVT. However, the potential biological pathway between EA and SVT remains unknown.
MR minimizes the possibility of bias inherent to observational studies[28]. However, genetic variants may be associated with more than one genetic phenotype, resulting in pleiotropy[29]. Since pleiotropy may bias the causal estimation of MR, we also used sensitivity analysis to verify the validity of the MR results. In the sensitivity analysis, the weighted median estimator and MR-Egger regression gave opposite results. However, MR-Egger regression has less precision and power, while the weighted median estimator provides valid estimates even if 50% of the SNPs are not valid instruments[30]; thus, the estimation results of the weighted median method may be more accurate than those of the MR-Egger analysis. Meanwhile, the results of the weighted median method were consistent with those of the IVW and MR-PRESSO results. MR-PRESSO methods detect outlier SNPS of potential level multipotency and assess whether exclusion of outlier SNPS affects the causal estimate[31]. Moreover, in all sensitivity analyses, the results tended to show a negative relationship between EA and SVT.
There are several limitations of this study. First, the population involved in this study only consisted of individuals with European ancestry. As ethnicity may affect causality, more studies involving different populations are required to verify our conclusions. Second, EA in this study was determined by the number of years of education, which may not be completely representative of an individual’s EA.
Importantly, without social and political reforms, it will be difficult to achieve the goal of direct intervention in education. Based on the results of this study, it is reasonable to conclude that increased screening for SVT among people with low EA would reduce its public health burden.
In conclusion, MR analysis suggests a potential negative causal association between EA and the occurrence of SVT, ultimately indicating that education may serve as a protective factor in the pathogenesis of SVT. Further research may build upon these findings to identify potential mechanisms underlying the impact of EA on the risk of SVT. The results of this study have significant implications for policymakers, as they identify potential strategies for reducing health education inequalities.