Does Educational Level Predict Mortality After Myocardial Infarction Independently of Left Ventricular Function and Medical Treatment?

I read the article by Consuegra-Sánchez et al with great interest. In their study, the authors report an inverse and independent relationship between educational level and longterm mortality in post-myocardial infarction patients. I would like to make a few points about the methodology and results of the article. In their study, the authors report the mean left ventricular ejection fraction (LVEF) of all patients and indicate LVEF as a predictor of long-term mortality. However, there are no data about the mean LVEF for each group. It is known that LVEF < 40% is an independent predictor of mortality after myocardial infarction. Therefore, the authors should state the mean LVEF and incidence of patients with LVEF < 40% for each group and compare the mean LVEF among the groups. A higher incidence of patients with LVEF < 40% in illiterate and primary education patient groups may be another significant reason for higher mortality rates. Additionally, the study by Consuegra-Sánchez et al includes patients with impaired left ventricle systolic function (mean LVEF = 49% for all patients). Aldosterone antagonists significantly reduce all-cause mortality in post-myocardial infarction patients with LVEF < 40%, in addition to standard medical therapy. In the study by Consuegra-Sánchez et al, there are no data on the incidence of patients treated with aldosterone antogonists. A higher incidence of treatment with aldosterone antagonists in secondary education and higher education patient groups may be the reason for lower mortality rates.