High CVD Risk Factors Among Hispanic and Latino Americans

Pauline Anderson

November 06, 2012

Americans of Hispanic and Latino backgrounds have a disturbingly high rate of major cardiovascular risk factors, such as hypertension, hypercholesterolemia, and obesity, a new study has found.

Results showed 71% of women and 80% of men from Hispanic or Latino communities have at least 1 major risk factor. Residents of Puerto Rican background, especially women, have the highest prevalence of cardiovascular risk factors.

"This is a very disturbing finding, and it's very sad," said study author, Martha L. Daviglus, MD, PhD, from the University of Illinois at Chicago and Northwestern University Feinberg School of Medicine. "We need to educate physicians and the public in general and perhaps change policies, to make sure that these populations are going to change their lifestyle habits; otherwise we are looking at the worst epidemic of cardiovascular diseases in the future."

The results are published in the November 7 issue of the Journal of the American Medical Association (JAMA). They were released online November 5 to coincide with their presentation at the American Heart Association Scientific Sessions 2012.

Dramatic Differences

The Hispanic Community Health Study/Study of Latinos included more than 15,000 participants aged 18 to 74 years who were of Cuban (n = 2201), Dominican (n = 1400), Mexican (n = 6232), Puerto Rican (n = 2590), Central American (n = 1634), and South American (n = 1022) backgrounds. More than two thirds of these participants (70%) had lived in the United States for 10 or more years.

The analysis included measurements of adverse cardiovascular disease (CVD) risk factors defined by using national guidelines for hypercholesterolemia, hypertension, obesity, diabetes, and smoking. Researchers determined the prevalence of coronary heart disease (CHD) and stroke from self-reported data.

The study found "quite dramatic differences" among the various Hispanic and Latino groups, said Dr. Daviglus. For example, Puerto Rican participants had the highest obesity rate (40.9% for men and 34.7% for women) and the highest current smoking rate (51.4% for men and 31.7% for women), whereas the prevalence of hypercholesterolemia was highest among Central American men (54.9%) and Puerto Rican women (41.0%).

Age- and sex-adjusted prevalence of 3 or more risk factors was highest in Puerto Rican participants (25.0%) and significantly higher (P  <  .001) among participants with less education (16.1%), those who were born in the United States (18.5%), and those who had lived in the United States 10 years or longer (15.7%) and so may be more acclimatized to the culture, said Dr. Daviglus.

The study also showed that hypertension and smoking were directly associated with CHD in both men and women, as were hypercholesterolemia and obesity in women and diabetes in men (odds ratios, 1.5 to 2.2). For stroke, associations were positive with hypertension in both sexes, diabetes in men, and smoking in women (odds ratios, 1.7 to 2.6).

Important Study

The researchers feel this is an important study because it is the first of such magnitude that includes a large range of populations from different Hispanic backgrounds, said Dr. Daviglus, who is of Bolivian heritage.

Lifestyle factors are at the root of the problem, said Dr. Daviglus. "We have known for long time that eating too many calories and exercising too little is going to cause most of these risk factors." She added that many Americans of Latino background eat prepared foods that "are loaded with salt," which can lead to hypertension.

She expressed concern that the "shocking" statistic that more than half of certain Latino populations have hypercholesterolemia won't be enough to spur lifestyle changes because too many think they can just take a drug, without having to change eating or activity habits.

"Many people think that it's easier to just take a medication to lower cholesterol levels because they don't have to make any sacrifices, but we don't know what will happen later on, after decades of taking medication."

Education and efforts at raising awareness should be targeted to individual communities, said Dr. Daviglus. "Maybe we can find a way to provide advice that is appropriate for the different cultures."

In the last decades, the US Hispanic and Latino population has increased dramatically and now makes up the nation's largest minority group. It’s difficult to get an exact estimate of the percentage of Americans these groups represent, but it’s probably more than 10%, with larger centers having a greater proportion, said Dr. Daviglus.

Dr. Daviglus hopes to carry out another study that investigates the differences in risk factors of the different populations based on their continent of origin, for example, separating out those from South American countries and those from Central America.

The Hispanic Community Health Study/Study of Latinos was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina, University of Miami, Albert Einstein College of Medicine, Northwestern University, and San Diego State University. The following institutes, centers, or offices contribute to the HCHS/SOL through a transfer of funds to the NHLBI: National Center on Minority Health and Health Disparities, the National Institute on Deafness and Other Communications Disorders, the National Institute of Dental and Craniofacial Research, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, and the Office of Dietary Supplements. Dr. Daviglus has disclosed no relevant financial relationships.

JAMA. Published online November 5, 2012. 2012;308:1775-1784. Abstract