Assessing the risk of heart attack and stroke among Hispanics

November 5, 2012, University of Miami

A study published today in the Journal of the American Medical Association (JAMA) indicated that many Hispanic/Latino adults living in the United States are at high risk for heart attack or stroke. This risk is highest in men and in older people, born in the US or that have lived in the US more than 10 years, that prefer to speak English, are lower income, or never finished high school.

"The finding that longer residence in the US increases disease risk may seem counterintuitive, but has previously been reported," says study co-author Schneiderman, James L. Knight Professor of Psychology, Medicine, and Psychiatry and Behavioral Sciences, at the University of Miami (UM).

The study also found that and stroke among Hispanics is most highly related to smoking and , but other are important. The treatable risk factors examined were smoking, blood pressure, cholesterol, obesity and diabetes. Using national guidelines as a comparison, the study found that Puerto Ricans are the most likely to have three or more risk factors and these usually include smoking and obesity. Cubans and South Americans are the least likely to have diabetes.

The research findings in JAMA come from the Hispanic Community /Study of Latinos, informally called SOL. It is the largest study of Hispanic ever sponsored by the National Institutes of Health (NIH) with the National Heart, Lung and Blood Institute and six other institutes, centers and offices of NIH providing support. SOL's purpose is to determine the health of Hispanics living in the US and to find out the factors that reduce or increase the risk of chronic disease.

The study examined 16,415 randomly selected Hispanic adults living in Miami, Chicago, New York's Bronx, and San Diego between 2008 and 2011. This allowed the SOL investigators to examine the health and of people from different Hispanic backgrounds including , Dominicans, Mexicans, , Central Americans and South Americans.

"Before today, most of what was known about the extent of heart attacks, strokes and risk factors in Hispanics came primarily from studies of Mexican Americans, who are the largest group of Hispanics living in the US, "says Schneiderman, Principal Investigator of the Miami Field Center of SOL at the UM. "The findings reported today in JAMA show that there are some important differences in risk factors among people from diverse Hispanic backgrounds."

Of the more than 16,000 Hispanic adults in SOL, over 4,000 participants were examined in the Miami Field Center. These participants were recruited from a randomly pre-specified list of addresses in the cities of Hialeah, Miami and Coral Gables. Although slightly more than half of the participants reported Cuban ancestry, the Center also had the opportunity to examine fairly large numbers of participants from Central or South American backgrounds.

"Because the examiners were comfortable conversing in Spanish or English, each participant was able to choose to speak in either language during the examination," Schneiderman says. "Most chose Spanish."

All SOL participants are followed each year. Therefore SOL will be able in the future to determine which risk factors and protective factors directly influence the development of heart disease, stroke, lung diseases and other chronic illnesses. Current plans are for a second examination to be conducted on the present SOL participants between 2014 and 2017 with follow-up continuing until 2019.

"The SOL participants and SOL investigators have developed a strong, positive long-term relationship that will allow the Hispanic community to gain a critical understanding of the status of Hispanic health in the US and the risks and protective behaviors that can influence Hispanic health," Schneiderman says. The study is titled "Prevalence of Major Cardiovascular Risk Factors and Cardiovascular Diseases among Hispanics/ Latinos of Diverse National Backgrounds in the US." Other authors of the JAMA article are Martha L. Daviglus, professor of Medicine, University of Illinois, Chicago; Gregory A. Talavera, professor of Public Health, San Diego State University; Larissa Avilés-Santa, project officer, National Heart Lung and Blood Institute, NIH; Matthew Allison, assistant professor of Behavioral Medicine, University of California, San Diego; Jianwen Cai, professor of biostatistics, University of North Carolina, Chapel Hill; Michael H. Criqui, professor of Family and Preventive Medicine, University of California, San Diego; Marc Gellman, research associate professor of psychology, University of Miami; Aida L. Giachello, professor of Preventive Medicine, Northwestern University; Natalia Gouskova, biostatistician, University of North Carolina, Chapel Hill; Robert C. Kaplan, professor of Epidemiology and Population Health, Albert Einstein College of Medicine; Lisa LaVange, professor of Biostatistics, University of North Carolina, Chapel Hill; Frank Penedo, professor of Medical Social Science, Northwestern University; Krista Perreira, professor of Public Policy, University of North Carolina, Chapel Hill; Amber Pirzada, research associate in Preventive Medicine, Northwestern University; Sylvia Wassertheil-Smoller, professor of Epidemiology and Population Health, Albert Einstein College of Medicine Paul D. Sorlie, deputy project officer, Heart, Lung and Blood Institute, NIH, and Jeremiah Stamler, professor Emeritus of , Northwestern University.

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