US Hispanics at high risk for cardiovascular disease

In a study that involved more than 16,000 Hispanic/Latino men and women living in the United States, the prevalence of major cardiovascular disease (CVD) risk factors was high and varied markedly across different background groups; and those born in the U.S. were more likely to report a history of coronary heart disease and stroke and to have multiple CVD risk factors, according to a study appearing in November 7 issue of JAMA, a theme issue on cardiovascular disease. The study is being released early online to coincide with the American Heart Association's Scientific Sessions.

In the last decades, the U.S. Hispanic and Latino population has increased dramatically, now comprising the nation's largest minority group. Cardiovascular diseases are leading causes of death among Hispanic/Latino individuals in the United States, and this relatively young ethnic group is at high risk of future CVD illness and death as it ages. "Risk for CVDs among Hispanic/Latino individuals has been reported to differ with acculturation and duration of residence in the United States," according to background information in the article. "Comprehensive data are limited regarding the prevalence of CVD risk factors in this population and relations of these traits to socioeconomic status (SES) and acculturation."

Martha L. Daviglus, M.D., Ph.D., of the University of Illinois at Chicago and Northwestern University Feinberg School of Medicine, and Gregory A. Talavera, M.D., M.P.H., of San Diego State University, and colleagues conducted a study to examine the prevalence of major CVD risk factors and CVD (coronary heart disease [CHD] and stroke) among U.S. Hispanic/Latino individuals of different backgrounds. The multicenter, population-based Hispanic Community Health Study/Study of Latinos included individuals of Cuban (n = 2,201), Dominican (n = 1,400), Mexican (n = 6,232), Puerto Rican (n = 2,590), Central American (n = 1,634), and South American backgrounds (n = 1,022), ages 18 to 74 years. The analyses involved 15,079 participants (5,979 men; 9,100 women) with complete data enrolled between March 2008 and June 2011. Seventy percent had lived in the United States for 10 or more years. The study included measurements of adverse CVD risk factors defined using national guidelines for hypercholesterolemia (high cholesterol), hypertension, obesity, diabetes, and smoking. Prevalence of CHD and stroke were determined from self-reported data.

The researchers found that large proportions of participants (80 percent of men, 71 percent of women) had at least one risk factor. Overall, 31 percent of men had an adverse level of any 1 major risk factor only (most commonly hypercholesterolemia); 28 percent and 21 percent had any 2 only or 3 or more risk factors. Prevalence of 3 or more risk factors was highest among Puerto Rican men and lowest among South American men. Among women, 30 percent had 1 risk factor only (most commonly obesity); 23 percent and 17 percent had any 2 or 3 or more risk factors. Prevalence of 3 or more risk factors was highest among Puerto Rican women and lowest among South American women.

The prevalence of 3 or more risk factors was significantly higher with lower education or income. "In general, participants with lower income or education had higher rates of smoking, diabetes, obesity, and hypercholesterolemia. Compared with those who were less acculturated (i.e., were foreign-born or first-generation immigrants, had lived in the United States <10 years, or for whom Spanish was the preferred language), more acculturated participants had higher prevalence of 3 or more risk factors." In general, more acculturated participants had markedly higher rates of current smoking and obesity compared with others.

For the different risk factors, the overall prevalence of hypercholesterolemia was 52 percent among men and 37 percent among women; 25 percent of men and 24 percent of women had hypertension; about 37 percent of men and 43 percent of women were obese; 17 percent of men and women had diabetes; and about 26 percent of men, as well as 15 percent of women, were current smokers.

"Overall, self-reported CHD and stroke prevalence were low (4.2 percent and 2.0 percent in men; 2.4 percent and 1.2 percent in women, respectively). In multivariate-adjusted models, hypertension and smoking were directly associated with CHD in both sexes as were hypercholesterolemia and obesity in women and diabetes in men," the authors write.

"In conclusion, findings from [this study] demonstrate the pervasive burden of CVD risk factors in all Hispanic/Latino groups in the United States and identify specific groups by origin, sociodemographic characteristics, and sociocultural backgrounds at particularly high risk of CVD. These data may enhance the impetus to implement interventions to lower the burden of CVD risk factors among Hispanic/Latino people overall and targeted at-risk groups, as well as develop strategies to prevent future development of adverse CVD risk factors starting at the youngest ages."

More information: JAMA .2012; 308[17]: 1775-1784.

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