PT - JOURNAL ARTICLE AU - Ibrahim Al-Zakwani AU - Ruth M Mabry AU - Mohammad Zubaid AU - Alawi A Alsheikh-Ali AU - Wael Almahmeed AU - Abdullah Shehab AU - Wafa Rashed TI - Association between education and major adverse cardiac events among patients with acute coronary syndrome in the Arabian Gulf AID - 10.1136/bmjgh-2018-001278 DP - 2019 Jan 01 TA - BMJ Global Health PG - e001278 VI - 4 IP - 1 4099 - http://gh.bmj.com/content/4/1/e001278.short 4100 - http://gh.bmj.com/content/4/1/e001278.full AB - Introduction The objective of this study was to evaluate the association between education and major adverse cardiac events in patients with acute coronary syndrome (ACS) in the Arabian Gulf.Methods Data were analysed from 3874 consecutive patients diagnosed with ACS admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013. Education was defined as any type of formal training from primary school and above. MACE included stroke/transient ischaemic attack (TIA), myocardial infarction (MI), all-cause mortality and readmissions for cardiac reasons.Results The overall mean age was 60±13 years and 67% (n=2579) were men. A total of 53% (n=2039) of the patients had some form of school education. Adjusting for demographic and clinical characteristics as well as socioeconomic measures (insurance type and employment), at 12-month follow-up, educated patients were significantly less likely to have had MACE (adjusted OR (aOR): 0.55; 95% CI 0.44 to 0.68; p<0.001) than those with no formal education. The lower rate of events was also consistent across all MACE components: stroke/TIA (aOR: 0.56; 95% CI 0.33 to 0.94; p=0.030), MI (aOR: 0.58; 95% CI 0.38 to 0.86; p=0.008), all-cause mortality (aOR: 0.58; 95% CI 0.39 to 0.87; p=0.009) and readmissions for cardiac reasons (aOR: 0.61; 95% CI 0.48 to 0.77; p<0.001). MACE outcomes were consistent across men and women and across countries.Conclusions Education was associated with lower MACE events in patients with ACS in the Arabian Gulf. Interventions promoting healthy lifestyles and management of clinical risk factors for patients with low health literacy are urgently required.