145 Cardiovascular risk factors by educational level in CHD patients: SURF CHD II 6 program (50.5%), with important variation by country-income status: participation was 74.5% in HICs, 25.7% in UMICs and 21.8% in LMICs (Figure 1, Supplementary Table 1). Higher educational level was positively associated with the use of antiplatelet medication and antihypertensives (HICs), lipid-lowering drugs (HICs and LMICs), but negatively associated with and insulin among diabetics and lipid-lowering drugs in UMICs. Higher education was strongly associated with participation in cardiac rehabilitation in HICs and UMICs (Table 3). Sensitivity analysis Levels of risk factor recording for some variables, such as physical activity, BMI and blood lipids, were lower among patients whose data was collected through pre-existing sources HIC UMIC LMIC Target attainmenta Never or former smoking 1.71 (1.43-2.04) 1.14 (0.88-1.47) 1.99 (1.53-2.59) Physical activity 1.94 (1.59-2.35) 2.48 (1.96-3.14) 1.75 (1.41-2.13) BMI 1.06 (0.84-1.34) 1.10 (0.81-1.51) 0.89 (0.71-1.11) Waist circumference 1.30 (0.82-2.12) 0.63 (0.37-1.10) 0.86 (0.53-1.40) Blood pressure 0.64 (0.53-0.77) 1.02 (0.83-1.27) 0.92 (0.75-1.14) non-HDL Cholesterol 1.01 (0.79-1.30) 0.92 (0.64-1.35) 1.19 (0.94-1.49) LDL 1.8 1.23 (1.05-1.45) 0.74 (0.55-1.01) 1.30 (1.04-1.63) LDL 1.4 0.94 (0.78-1.13) 0.65 (0.44-1.00) 1.21 (0.93-1.58) Triglycerides 0.85 (0.66-1.09) 1.32 (1.01-1.72) 1.14 (0.91-1.44) Hba1cb 0.82 (0.45-1.36) 0.89 (0.53-1.50) 1.20 (0.80-1.82) Treatment Antiplatelets 1.66 (1.22-2.23) 1.285 (0.97-1.69) 1.5 (0.94-2.35) Antihypertensives 1.995 (1.32-2.96) 0.72 (0.48-1.05) 1.03 (0.64-1.63) Lipid-lowering 1.424 (1.05-1.90) 0.62 (0.48-0.79 1.75 (1.20-2.55) Oral hypoglicemics 1.43 (0.94-2.16) 1.08 (0.78-1.49) 1.26 (0.92-1.72) Insulinb 1.10 (0.70-1.73) 0.43 (0.30-0.61) 0.88 (0.59-1.34) Cardiac rehabilitation 2.47 (2.10-2.91) 4.89 (3.44-7.18) 1.24 (0.99-1.56) Table 3. Results multivariable analysis showing odds ratios for achieving risk factor targets, being on medication or participate in cardiac rehabilitation, secondary or tertiary educational level compared to primary education. Note: Results are expressed in odds ratios (95% confidence intervals) of achieving risk factor targets, and being on medication or participate in cardiac rehabilitation, if having secondary or tertiary education compared to primary education, adjusted by age, sex and type of center (public or private). aRisk factor targets are defined as: no smoking or smoking cessation, Moderately vigorous physical activity at least 30 minutes 3-5 times/week, BMI <25 kg/m2, waist circumference <94 cm in men (<90cm in South-East Asian men) and <80 cm in women, blood pressure <140/90 mmHg (<140/85 mmHg in diabetics), LDL <1.8mmol/L, LDL <1.4mmol/L, non-HDL cholesterol <2.2 mmol/L, triglycerides <1.7 mmol/L, and Hba1c (in diabetic patients) <7%. b Estimates are calculated among diabetic patients.
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