Higher levels of education in women are associated not only with a reduction in cardiovascular risk factors and mortality among women - but also among the men they marry!

While it has been shown in several research studies that married men live longer than men who are not married, there has been little research on whether a woman’s educational level has an effect on her husband’s risk of heart disease.

A few years ago, a group of researchers from Norway undertook a study to find out whether how well educated a woman was might influence coronary heart disease (CHD) risk factors in her husband - and whether this "spouse’s educational level" had any effect on mortality from heart disease.

Many studies have shown that socio-economic status (SES) does have a significant bearing on heart health. Low socio-economic status has been shown to be an established risk factor for coronary heart disease (CHD) mortality; the lower down the socio-economic scale a man is, the greater his risk of developing heart disease and dying early from a heart attack.

Postulating that wives’ education has a protective effect on their husband’s risk of CHD because women do play an important role in shaping the lifestyle and health behaviours of the family - and that the better educated a woman is the better able she would be to improve the economic standing of her household – a team of research workers led by Dr. Randi Selmer of Norway’s National Health Screening Service Research Department decided to examine whether, after taking into account the men’s own educational level, the education level of their wives’ was linked to these men’s risk of heart disease and heart attacks.

The research team identified married men from a cohort of patients recruited for the Second Cardiovascular Disease and Risk Factor Screening Survey conducted by Norway’s National Health Screening Service. These men were aged between 35–56 years at the time of entry into the study and of 29,350 eligible men, 26, 366 (90%) participated in the survey. Eighty two percent of these men were married. The results were analysed for each level of a man’s education to see if the man’s wife’s educational level was associated with a difference in his heart health.

Among the interesting findings from this study (A man’s heart and a wife’s education: A 12-year coronary heart disease mortality follow-up in Norwegian men by Grace M Egeland, Aage Tverdal, Haakon E Meyer and Randi Selmer, published in the 2002 International Journal of Epidemiology 31:799-805) were that the younger the men were, the less likely they were to have wives with less than eight years’ education - implying that over the years, more women were remaining in school and going on to longer periods of education. They also discovered that men with wives having eight or more years of education were less likely

* to be sedentary or overweight

* to have high systolic and diastolic blood pressure

* to have high cholesterol

* to smoke

* to have had either angina or a heart attack

Over the 12 years of the study, 556 CHD deaths had been observed among the 20,038 men. Analysing these results statistically, the authors say "wives’ education showed a stronger inverse trend with men’s CHD mortality than did men’s own educational level in age-adjusted analyses".

In other words, the wife’s level of education had a better effect in protecting men from dying from heart disease than even the man’s own educational level!

These recent findings from Norway appear to be at variance with those from the oft-quoted 1948 Framingham Heart Study done in the USA - where after 10 years of follow-up of 269 spouse pairs, men married to women with 13 years or more of education were 2.6 times more likely to develop CHD (the majority of which was angina pectoris) than men married to women with a grammar school education.

The Norway study, however, is in keeping with the findings of a more recent study from Holland and Lithuania which showed, in a cohort of 2,452 Lithuanian and 3,365 Dutch men, that an educated wife protected husbands against CHD mortality. This protective influence of wives’ education remained apparent after controlling for men’s educational level and numerous CHD risk factors.

There may be several explanations for the findings from the Norwegian study. Nordic countries are considered to be more egalitarian than many other countries, and perceptions regarding women and education may be considerably different from that of other cultures. Moreover, research findings from the Framingham study done in the last century cannot be extrapolated to 21st century Scandinavia - or for that matter, to many other countries in the present age, where men and women are better educated, better informed and better employed than in 1948 Massachusetts.

* The better educated a wife is, the lower is her husband’s risk for CHD mortality.

* The beneficial effect of wives’ education increased with increasing level of her husband’s education.