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Thompson CA, Boothroyd DB, Hastings KG, Cullen MR, Palaniappan LP, Rehkopf DH. A Multiple-Imputation "Forward Bridging" Approach to Address Changes in the Classification of Asian Race/Ethnicity on the US Death Certificate. Am J Epidemiol 2018; 187:347-357. [PMID: 29401361 DOI: 10.1093/aje/kwx215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/31/2017] [Indexed: 12/18/2022] Open
Abstract
The incomparability of old and new classification systems for describing the same data can be seen as a missing-data problem, and, under certain assumptions, multiple imputation may be used to "bridge" 2 classification systems. One example of such a change is the introduction of detailed Asian-American race/ethnicity classifications on the 2003 version of the US national death certificate, which was adopted for use by 38 states between 2003 and 2011. Using county- and decedent-level data from 3 different national sources for pre- and postadoption years, we fitted within-state multiple-imputation models to impute ethnicities for decedents classified as "other Asian" during preadoption years. We present mortality rates derived using 3 different methods of calculation: 1) including all states but ignoring the gradual adoption of the new death certificate over time, 2) including only the 7 states with complete reporting of all ethnicities, and 3) including all states and applying multiple imputation. Estimates from our imputation model were consistently in the middle of the other 2 estimates, and trend results demonstrated that the year-by-year estimates of the imputation model were more similar to those of the 7-state model. This work demonstrates how multiple imputation can provide a "forward bridging" approach to make more accurate estimates over time in newly categorized populations.
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Affiliation(s)
- Caroline A Thompson
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Derek B Boothroyd
- Quantitative Sciences Unit, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Katherine G Hastings
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Mark R Cullen
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Latha P Palaniappan
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - David H Rehkopf
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
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Lagisetty PA, Wen M, Choi H, Heisler M, Kanaya AM, Kandula NR. Neighborhood Social Cohesion and Prevalence of Hypertension and Diabetes in a South Asian Population. J Immigr Minor Health 2018; 18:1309-1316. [PMID: 26527589 DOI: 10.1007/s10903-015-0308-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
South Asians have a high burden of cardiovascular disease compared to other racial/ethnic groups in the United States. Little has been done to evaluate how neighborhood environments may influence cardiovascular risk factors including hypertension and type 2 diabetes in this immigrant population. We evaluated the association of perceived neighborhood social cohesion with hypertension and type 2 diabetes among 906 South Asian adults who participated in the Mediators of Atherosclerosis in South Asians Living in America Study. Multivariable logistic regression adjusted for demographic, socioeconomic, psychosocial, and physiologic covariates. Subgroup analyses examined whether associations differed by gender. South Asian women living in neighborhoods with high social cohesion had 46 % reduced odds of having hypertension than those living in neighborhoods with low social cohesion (OR 0.54, 95 % CI 0.30-0.99). Future research should determine if leveraging neighborhood social cohesion prevents hypertension in South Asian women.
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Affiliation(s)
- Pooja A Lagisetty
- Robert Wood Johnson Foundation Clinical Scholar, Department of General Internal Medicine, University of Michigan, NCRC Bldg. 10, Rm G016-4A, 2800 Plymouth Rd., Ann Arbor, MI, 48109-2800, USA.
| | - Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Hwajung Choi
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michele Heisler
- Robert Wood Johnson Foundation Clinical Scholar, Department of General Internal Medicine, University of Michigan, NCRC Bldg. 10, Rm G016-4A, 2800 Plymouth Rd., Ann Arbor, MI, 48109-2800, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Namratha R Kandula
- Department of Medicine and Preventive Medicine, Northwestern University, Chicago, IL, USA
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Ardeshna DR, Bob-Manuel T, Nanda A, Sharma A, Skelton WP, Skelton M, Khouzam RN. Asian-Indians: a review of coronary artery disease in this understudied cohort in the United States. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:12. [PMID: 29404358 DOI: 10.21037/atm.2017.10.18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery disease (CAD) is a major cause of cardiovascular death worldwide. Prevalence of CAD is highly variable among different races. Asian Indians have been noted to have the highest CAD rates and the conventional risk factors fail to explain this difference completely. Asian Indians constitute a fifth of the global population, and the higher rates of CAD in this population constitute a major health challenge. There have been studies in the early 2000s that investigate the risk factors in this population; however, very few studies have been done since then that explore the higher CAD rates in Asian Indians. This is a comprehensive and current review of the known risk factors for CAD in Asian Indians and strategies physicians should consider relieving this burden.
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Affiliation(s)
- Devarshi R Ardeshna
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tamunoinemi Bob-Manuel
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Amit Nanda
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Arindam Sharma
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - William Paul Skelton
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA
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El-Assaad I, Al-Kindi SG, Aziz PF. Trends of Out-of-Hospital Sudden Cardiac Death Among Children and Young Adults. Pediatrics 2017; 140:peds.2017-1438. [PMID: 29180463 DOI: 10.1542/peds.2017-1438] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous estimates of sudden cardiac death in children and young adults vary significantly, and population-based studies in the United States are lacking. We sought to estimate the incidence, causes, and mortality trends of sudden cardiac death in children and young adults (1-34 years). METHODS Demographic and mortality data based on death certificates for US residents (1-34 years) were obtained (1999-2015). Cases of sudden death and sudden cardiac death were retrieved by using the International Classification of Diseases, 10th Revision codes. RESULTS A total of 1 452 808 subjects aged 1 to 34 years died in the United States, of which 31 492 (2%) were due to sudden cardiac death. The estimated incidence of sudden cardiac death is 1.32 per 100 000 individuals and increased with age from 0.49 (1-10 years) to 2.76 (26-34 years). During the study period, incidence of sudden cardiac death declined from 1.48 to 1.13 per 100 000 (P < .001). Mortality reduction was observed across all racial and ethnic groups with a varying magnitude and was highest in children aged 11 to 18 years. Significant disparities were found, with non-Hispanic African American individuals and individuals aged 26 to 34 years having the highest mortality rates. The majority of young children (1-10 years) died of congenital heart disease (n = 1525, 46%), whereas young adults died most commonly from ischemic heart disease (n = 5075, 29%). CONCLUSIONS Out-of-hospital sudden cardiac death rates declined 24% from 1999 to 2015. Disparities in mortality exist across age groups and racial and ethnic groups, with non-Hispanic African American individuals having the highest mortality rates.
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Affiliation(s)
- Iqbal El-Assaad
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, Ohio; and
| | - Sadeer G Al-Kindi
- Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, Ohio
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Deol R, Lee KA, Kandula NR, Kanaya AM. Risk of Obstructive Sleep Apnoea is Associated with Glycaemia Status in South Asian Men and Women in the United States. ACTA ACUST UNITED AC 2017; 9:1-6. [PMID: 29354780 DOI: 10.1016/j.obmed.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims To examine the association between glycaemia status and the risk for obstructive sleep apnoea (OSA) in a cohort of South Asians living in the United States. Methods A secondary analysis of a community based cohort of 899 participants from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The Berlin Questionnaire was used to screen for OSA. Results Almost one in four (24%) South Asians was at high risk for OSA. Compared to the normal glucose tolerance group (18%), high risk of OSA was significantly more likely in the prediabetes (24%) and diabetes (32%) groups (p = .007). More men (28%) than women (18%) were at high risk of OSA. Risk for OSA was also associated with higher haemoglobin A1c values, hypertension, large waist circumference, and BMI > 27.5 kg/m2. In a multivariate regression analysis, sleep disordered breathing (SDB) remained significantly associated with higher haemoglobin A1c values, even after controlling for waist circumference and other demographic and clinical factors. Conclusions The risk for SDB and OSA was high among South Asian men and women. Given the association between dysglycaemia and risk for OSA, these health issues require simultaneous clinical assessment. Future studies using objective sleep measures such as polysomnography are warranted in the diagnosis and treatment of OSA in the South Asian adult population already at high risk for dysglycaemia.
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Affiliation(s)
- Rupinder Deol
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143
| | - Namratha R Kandula
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Alka M Kanaya
- Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA 94115
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Singh A, Collins BL, Gupta A, Fatima A, Qamar A, Biery D, Baez J, Cawley M, Klein J, Hainer J, Plutzky J, Cannon CP, Nasir K, Di Carli MF, Bhatt DL, Blankstein R. Cardiovascular Risk and Statin Eligibility of Young Adults After an MI: Partners YOUNG-MI Registry. J Am Coll Cardiol 2017; 71:292-302. [PMID: 29141201 DOI: 10.1016/j.jacc.2017.11.007] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite significant progress in primary prevention, the rate of MI has not declined in young adults. OBJECTIVES The purpose of this study was to evaluate statin eligibility based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age. METHODS The YOUNG-MI registry is a retrospective cohort from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation. RESULTS Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) men (p < 0.001). CONCLUSIONS The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.
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Affiliation(s)
- Avinainder Singh
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bradley L Collins
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ankur Gupta
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amber Fatima
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Arman Qamar
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Biery
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julio Baez
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mary Cawley
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Josh Klein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge Plutzky
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher P Cannon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Khurram Nasir
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deepak L Bhatt
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Singh V, Prabhakaran S, Chaturvedi S, Singhal A, Pandian J. An Examination of Stroke Risk and Burden in South Asians. J Stroke Cerebrovasc Dis 2017; 26:2145-2153. [PMID: 28579510 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/12/2017] [Accepted: 04/29/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND South Asians (India, Pakistan, Sri Lanka, Bangladesh, Nepal, and Bhutan) are at a disproportionately higher risk of stroke and heart disease due to their cardiometabolic profile. Despite evidence for a strong association between diabetes and stroke, and growing stroke risk in this ethnic minority-notwithstanding reports of higher stroke mortality irrespective of country of residence-the explanation for the excess risk of stroke remains unknown. METHODS We have used extensive literature review, epidemiologic studies, morbidity and mortality records, and expert opinions to examine the burden of stroke among South Asians, and the risk factors identified thus far. RESULTS We summarize existing evidence and indicate gaps in current knowledge of stroke epidemiology among South Asian natives and immigrants. CONCLUSIONS This research focuses attention on a looming epidemic of stroke mainly due to modifiable risk factors, but also new determinants that might aggravate the effect of vascular risk factors in South Asians causing more disabling strokes and death.
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Affiliation(s)
- Vineeta Singh
- Department of Neurology, University of California San Francisco, San Francisco, California.
| | | | - Seemant Chaturvedi
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Aneesh Singhal
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
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Morales-Estrella JL, Ciftci FD, Trick WE, Hinami K. Physical symptoms screening for cardiopulmonary complications of obesity using audio computer-assisted self-interviews. Qual Life Res 2017; 26:2085-2092. [DOI: 10.1007/s11136-017-1549-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 12/24/2022]
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Talegawkar SA, Jin Y, Kandula NR, Kanaya AM. Cardiovascular health metrics among South Asian adults in the United States: Prevalence and associations with subclinical atherosclerosis. Prev Med 2017; 96:79-84. [PMID: 28007496 PMCID: PMC5329127 DOI: 10.1016/j.ypmed.2016.12.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 02/08/2023]
Abstract
South Asians, a fast growing ethnic group in the US, have an increased risk for cardiovascular disease compared to the general population. We examined the prevalence and distribution of the American Heart Association's Life's Simple 7 cardiovascular health (CVH) metrics using data from Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and cross-sectional associations between number of CVH metrics in the ideal range with subclinical atherosclerosis assessed using coronary artery calcium (CAC) measured using cardiac computed tomography and carotid intima media thickness (CIMT) measured using high-resolution B-mode ultrasonography. CAC was modeled as Agatston scores=0, 1-400 and >400; CIMT was examined continuously and as internal CIMT>1.5mm. In the MASALA cohort (N=875; mean age: 55years; 53% men; living in greater San Francisco and Chicago areas; October 2010-March 2013) without prevalent coronary heart disease, no participant had all 7 metrics in ideal range; approximately 20% of the participants had at least 5 metrics in ideal range. Higher number of CVH metrics in the ideal range was inversely associated with subclinical atherosclerosis. A 1 unit increase in the number of CVH metrics in the ideal range was associated with 32% lower odds of CAC=1-400 (vs. CAC=0; OR=0.68, 95% CI: 0.60, 0.78) and 28% lower odds of internal CIMT>1.5mm (OR=72, 95% CI: 0.61, 0.85). These data show the prevalence of CVH metrics among South Asians in the US, and provide empirical evidence on inverse associations of meeting ideal levels for higher number of metrics and subclinical atherosclerosis.
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Affiliation(s)
- Sameera A Talegawkar
- Departments of Exercise and Nutrition Sciences and Epidemiology and Biostatistics, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, 2nd Floor, Washington, DC 20052, USA.
| | - Yichen Jin
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, 2nd Floor, Washington, DC 20052, USA
| | - Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Rubloff Building 10th Floor, 750 N Lake Shore, Chicago, IL 6061, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1545 Divisadero, San Francisco, CA 94115, USA
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Das A, Ambale-Venkatesh B, Lima JAC, Freedman JE, Spahillari A, Das R, Das S, Shah RV, Murthy VL. Cardiometabolic disease in South Asians: A global health concern in an expanding population. Nutr Metab Cardiovasc Dis 2017; 27:32-40. [PMID: 27612985 DOI: 10.1016/j.numecd.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 12/27/2022]
Abstract
Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.
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Affiliation(s)
- A Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - B Ambale-Venkatesh
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J A C Lima
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J E Freedman
- Department of Cardiology, UMass Memorial Health Care, MA, USA
| | - A Spahillari
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R Das
- The John Hopkins University, Baltimore, USA
| | - S Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R V Shah
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - V L Murthy
- Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, USA.
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Kwon SC, Rideout C, Patel S, Arista P, Tepporn E, Lipman J, Kunkel S, Le DQ, Chin KK, Trinh-Shevrin C. Improving Access to Healthy Foods for Asian Americans, Native Hawaiians, and Pacific Islanders: Lessons Learned from the STRIVE Program. J Health Care Poor Underserved 2016; 26:116-36. [PMID: 25981093 DOI: 10.1353/hpu.2015.0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) experience a large burden from certain chronic disease-related risk factors. The STRIVE Program funded four AANHPI community-based organizations (CBOs) to implement culturally adapted community gardens and farmers' markets to increase access to healthy foods. Key CBO informant interviews were conducted to understand processes and lessons learned.
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The association of duration of residence in the United States with cardiovascular disease risk factors among South Asian immigrants. J Immigr Minor Health 2016; 17:781-90. [PMID: 24380928 DOI: 10.1007/s10903-013-9973-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
South Asians are disproportionately impacted by cardiovascular disease (CVD). Our objective was to examine the association between duration of residence in the US and CVD risk factors among South Asian adult immigrants. Multivariate logistic regression analyses using pooled data from the 2005, 2007, 2009 California Health Interview Surveys. Duration of residence in the US < 15 years was significantly associated with overweight/obese BMI (OR 0.59; 95% CI 0.35, 0.98 for 5 to < 10 years), daily consumption of 5+ servings of fruits/vegetables (OR 0.37; 95% CI 0.15, 0.94 for 10 to < 15 years), and sedentary lifestyle (OR 2.11; 95% CI 1.17, 3.81 for 10 to < 15 years) compared with duration of residence ≥ 15 years after adjusting for illness burden, healthcare access, and socio-demographic characteristics. Duration of residence was not significantly associated with other CVD risk factors. Duration of residence is an important correlate of overweight/obesity and other risk factors among South Asian immigrants.
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Flueckiger P, Qureshi W, Michos ED, Blaha M, Burke G, Sandfort V, Herrington D, Yeboah J. Guideline-based statin/lipid-lowering therapy eligibility for primary prevention and accuracy of coronary artery calcium and clinical cardiovascular events: The Multi-Ethnic Study of Atherosclerosis (MESA). Clin Cardiol 2016; 40:163-169. [PMID: 27859433 DOI: 10.1002/clc.22642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND With multiple cholesterol guidelines, we evaluated the accuracy of recommended statin therapy on identifying coronary artery calcium (CAC) and cardiovascular disease (CVD) events by 2004 NCEP/ ATP III, 2016 ESC/EAS, and 2013 ACC/AHA guidelines. HYPOTHESIS ACC/AHA guidelines are more accurate in identifying persons at risk for CVD. METHODS 5002/6814 participants age <75 years and free of CVD were included. CAC categories (>0, ≥100, and ≥300) and 10 years of CVD outcomes were considered. Sensitivity (SN), specificity (SP), positive and negative predictive value (PPV and NPV), and likelihood ratios (LR) were calculated. Mean age was 59 years; 47% of subjects were males. RESULTS 1297 (26%), 1381 (28%), and 2538 (51%) had class I indications for statin/LLT by the NCEP ATP III, ESC/EAS, and AHA/ACC guidelines, respectively. SN, SP, NPV, and PPV for CAC ≥300 were: NCEP ATP III (41.1%, 75.5%, 93.3% and 13.4%), ESC/EAS (54.1%, 74.8%, 94.6% and16.6%), and ACC/AHA (87.2%, 52.6%, 97.8% and 14.5%). SN, SP, PPV, and NPV for corresponding CVD outcomes were: NCEP ATP III (45.8%, 75.1%, 96.3%, and 8.9%), ESC/EAS (50.5%, 72.9%, 98.7%, and 3.6%), and AHA/ACC (79.6%, 50.7%, 98%, and 7.7%). ESC/EAS had significantly higher positive LR 2.15 (95% CI, 1.95 - 2.38) and ACC/AHA had significantly lower negative LR [0.24, (95% CI 0.19 - 0.31)] for corresponding CVD. CONCLUSIONS Despite the increased in SN of statin eligibility by the ACC/AHA, it has similar NPV and PPV for CAC/future CVD events. The ACC/AHA class I indications for statin may be a superior screening tool for subclinical and clinical CVD.
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Affiliation(s)
- Peter Flueckiger
- Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Waqas Qureshi
- Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Veit Sandfort
- Radiology and Imaging Services, National Institutes of Health, Bethesda, Maryland
| | - David Herrington
- Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph Yeboah
- Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Shantsila E, Shantsila A, Gill PS, Lip GYH. Premature Cardiac Aging in South Asian Compared to Afro-Caribbean Subjects in a Community-Based Screening Study. J Am Heart Assoc 2016; 5:e004110. [PMID: 27930355 PMCID: PMC5210345 DOI: 10.1161/jaha.116.004110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND People of South Asian (SAs) and African Caribbean (AC) origin have increased cardiovascular morbidity, but underlying mechanisms are poorly understood. Aging is the key predictor of deterioration in diastolic function, which can be assessed by echocardiography using E/e' ratio as a surrogate of left ventricular (LV) filling pressure. The study aimed to assess a possibility of premature cardiac aging in SA and AC subjects. METHODS AND RESULTS We studied 4540 subjects: 2880 SA and 1660 AC subjects. All participants underwent detailed echocardiography, including LV ejection fraction, average septal-lateral E/e', and LV mass index (LVMI). When compared to ACs, SAs were younger, with lower mean LVMI, systolic blood pressure (BP), diastolic BP, and body mass index (BMI), as well as a lower prevalence of hypertension and smoking (P≤0.001 for all). In a multivariate linear regression model including age, sex, ethnicity, BP, heart rate, BMI, waist circumference, LVMI, history of smoking, hypertension, coronary artery disease, diabetes mellitus, medications, SA origin was independently associated with higher E/e' (regression coefficient±standard error, -0.66±0.10; P<0.001, adjusted R2 for the model 0.21; P<0.001). Furthermore, SAs had significantly accelerated age-dependent increase in E/e' compared to ACs. On multivariable Cox regression analysis without adjustment for E/e', SA ethnicity was independently predictive of mortality (P=0.04). After additional adjustment for E/e', the ethnicity lost its significance value, whereas E/e' was independently predictive of higher risk of death (P=0.008). CONCLUSIONS Premature cardiac aging is evident in SAs and may contribute to high cardiovascular morbidity in this ethnic group, compared to ACs.
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Affiliation(s)
- Eduard Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Alena Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Paramjit S Gill
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
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Dave SS, Craft LL, Mehta P, Naval S, Kumar S, Kandula NR. Life stage influences on U.S. South Asian women's physical activity. Am J Health Promot 2016; 29:e100-8. [PMID: 24717067 DOI: 10.4278/ajhp.130415-qual-175] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE South Asian (SA) women in the United States report extremely low rates of leisure time physical activity (PA) compared with women in other ethnic minority groups. This study explored SA women's perspectives on PA during different life stages. DESIGN This is a community-based participatory research study that used focus groups. SETTING The study setting was a community-based organization that provides social services to SA immigrants in Chicago, Illinois. PARTICIPANTS The study team conducted six focus groups (in English and Hindi) with 42 SA women, ages 18 to 71 years. METHOD A semistructured interview guide was used to foster discussion about perceptions of, barriers to/facilitators of, and suggestions for PA programs. Discussions were transcribed and independently coded by two reviewers using thematic content analysis and guided by a coding scheme that was developed a priori. RESULTS Participants said that different life stages strongly influenced their PA. PA decreased after marriage and having children. Chronic diseases constrained older women from more vigorous PA. Barriers to PA among younger women were family disapproval and perceptions that PA is unnecessary if you are "skinny." Women agreed that PA is not a priority within the culture, and that interventions must take into account cultural, religious, and family context. CONCLUSION Sociocultural norms, family constraints, and lack of awareness about the benefits of PA strongly influenced PA among SA women. Culturally salient intervention strategies might include programs in trusted community settings where women can exercise in women-only classes with their children, and targeted education campaigns to increase awareness about the benefits of PA across life stages.
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Fernandez RS, Everett B, Sundar S. Predictors of Heart Disease Knowledge Among Older and Younger Asian Indian Adults. J Immigr Minor Health 2016; 18:1378-1385. [PMID: 27234362 DOI: 10.1007/s10903-016-0437-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coronary heart disease (CHD) has been estimated to be the leading cause of mortality in developing countries in 2010, particularly among Asian Indians. When compared to other populations globally, Asian Indians less than 40 years of age are at an increased risk of myocardial infarction. The objective of this study was to identify the predictors of knowledge of heart disease among younger and older Asian Indians adults. A cross-sectional survey was undertaken in Sydney Australia. One hundred and forty-four participants of Asian Indian descent who attended the health promotion stall at the Australia India Friendship Fair in Sydney participated in the study. All participants completed a self-administered questionnaire. The Primary outcome of the survey was knowledge of heart disease as measured by the 25 item Heart Disease Facts Questionnaire. All six modifiable risk factors for heart disease namely smoking, high blood pressure, diabetes, high cholesterol, physical inactivity and overweight were identified by 45.2 % of those aged below 40 and 53.5 % of those aged above 40 years of age respectively. For younger adults, only smoking status was significant and was an independently predictor of knowledge related to CHD (b = -10.6, p = 0.001, sr2 = 0.16). For older adults, smoking status and duration of residence were significant predictors of knowledge related to CHD (b = -7.4, p = 0.000, sr2 = 0.24; b = 0.13, p = 0.001, sr2 = 0.069 respectively). Although suboptimal, there were no statistically significant differences in the level of knowledge among older and younger Asian Indians. Nevertheless, strategies to improve the knowledge of heart disease among this cohort are warranted.
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Affiliation(s)
- Ritin S Fernandez
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2520, Australia. .,Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW, Australia.
| | - Bronwyn Everett
- Centre for Applied Nursing Research, School of Nursing and Midwifery, University of Western Sydney, Parramatta, NSW, Australia.,Ingham Institute, South Western Sydney Local Health District, Sydney, NSW, Australia
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Lane KJ, Levy JI, Scammell MK, Peters JL, Patton AP, Reisner E, Lowe L, Zamore W, Durant JL, Brugge D. Association of modeled long-term personal exposure to ultrafine particles with inflammatory and coagulation biomarkers. ENVIRONMENT INTERNATIONAL 2016; 92-93:173-82. [PMID: 27107222 PMCID: PMC4902720 DOI: 10.1016/j.envint.2016.03.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Long-term exposure to fine particulate matter has been linked to cardiovascular disease and systemic inflammatory responses; however, evidence is limited regarding the effects of long-term exposure to ultrafine particulate matter (UFP, <100nm). We used a cross-sectional study design to examine the association of long-term exposure to near-highway UFP with measures of systemic inflammation and coagulation. METHODS We analyzed blood samples from 408 individuals aged 40-91years living in three near-highway and three urban background areas in and near Boston, Massachusetts. We conducted mobile monitoring of particle number concentration (PNC) in each area, and used the data to develop and validate highly resolved spatiotemporal (hourly, 20m) PNC regression models. These models were linked with participant time-activity data to determine individual time-activity adjusted (TAA) annual average PNC exposures. Multivariable regression modeling and stratification were used to assess the association between TAA-PNC and single peripheral blood measures of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor-necrosis factor alpha receptor II (TNFRII) and fibrinogen. RESULTS After adjusting for age, sex, education, body mass index, smoking and race/ethnicity, an interquartile-range (10,000particles/cm(3)) increase in TAA-PNC had a positive non-significant association with a 14.0% (95% CI: -4.6%, 36.2%) positive difference in hsCRP, an 8.9% (95% CI: -0.4%, 10.9%) positive difference in IL-6, and a 5.1% (95% CI: -0.4%, 10.9%) positive difference in TNFRII. Stratification by race/ethnicity revealed that TAA-PNC had larger effect estimates for all three inflammatory markers and was significantly associated with hsCRP and TNFRII in white non-Hispanic, but not East Asian participants. Fibrinogen had a negative non-significant association with TAA-PNC. CONCLUSIONS Our findings suggest an association between annual average near-highway TAA-PNC and subclinical inflammatory markers of CVD risk.
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Affiliation(s)
- Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States; Yale University School of Forestry & Environmental Studies, 195 Prospect Street, New Haven, CT, United States.
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Junenette L Peters
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Allison P Patton
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, United States; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
| | - Ellin Reisner
- Somerville Transportation Equity Partnership, Somerville, MA, United States
| | - Lydia Lowe
- Chinese Progressive Association, Boston, MA, United States
| | - Wig Zamore
- Somerville Transportation Equity Partnership, Somerville, MA, United States
| | - John L Durant
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, United States
| | - Doug Brugge
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, United States; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States; Jonathan M. Tisch College of Citizenship and Public Service
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Jayaprakash M, Puri-Taneja A, Kandula NR, Bharucha H, Kumar S, Dave SS. Qualitative Process Evaluation of a Community-Based Culturally Tailored Lifestyle Intervention for Underserved South Asians. Health Promot Pract 2016; 17:802-813. [PMID: 27225217 DOI: 10.1177/1524839916650165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction There are few examples of effective cardiovascular disease prevention interventions for South Asians (SAs). We describe the results of a process evaluation of the South Asian Heart Lifestyle Intervention for medically underserved SAs implemented at a community-based organization (CBO) using community-based participatory research methods and a randomized control design (n = 63). Method Interviews were conducted with 23 intervention participants and 5 study staff using a semistructured interview guide focused on participant and staff perceptions about the intervention's feasibility and efficacy. Data were thematically analyzed. Results Intervention success was attributed to trusted CBO setting, culturally concordant study staff, and culturally tailored experiential activities. Participants said that these activities helped increase knowledge and behavior change. Some participants, especially men, found that self-monitoring with pedometers helped motivate increased physical activity. Participants said that the intervention could be strengthened by greater family involvement and by providing women-only exercise classes. Staff identified the need to reduce participant burden due to multicomponent intervention and agreed that the CBO needed greater financial resources to address participant barriers. Conclusion Community-based delivery and cultural adaptation of an evidence-based lifestyle intervention were effective and essential components for reaching and retaining medically underserved SAs in a cardiovascular disease prevention intervention study.
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Affiliation(s)
| | | | | | | | - Santosh Kumar
- Metropolitan Asian Family Services, Chicago, IL, USA
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Pusalavidyasagar S, Sert Kuniyoshi FH, Shamsuzzaman ASM, Singh P, Maharaj S, Leinveber P, Nykodym J, Somers VK. Comparison of Endothelial Function in Asian Indians Versus Caucasians. Metab Syndr Relat Disord 2016; 14:363-7. [PMID: 27172431 DOI: 10.1089/met.2015.0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Asian Indians have markedly increased mortality due to coronary artery disease (CAD). Impaired endothelial function has been linked to an increased risk of acute cardiovascular events. We tested the hypothesis that endothelial function was attenuated in Asian Indians and Caucasians. METHODS We studied 14 Asian Indians [mean age: 30 ± 6 years; mean body mass index (BMI): 25 ± 3 kg/m(2)] and 11 Caucasians (mean age: 30 ± 5 years; mean BMI: 26 ± 2 kg/m(2)). All 25 subjects were healthy men and nonsmokers without any history of CAD or diabetes and were not taking medications. Endothelial function was evaluated by ultrasound measures of flow-mediated dilatation (FMD) and endothelium-independent nonflow mediated vasodilatation (NFMD) of the brachial artery, in the morning immediately after awakening (6 a.m.) in a fasting state. RESULTS Mean age, BMI, apnea-hypopnea index, heart rate, and blood pressure were similar in both groups (P = >0.05). When correcting for body surface area, brachial artery diameter was not different between the two groups (2.1% ± 0.3% vs. 2.2% ± 0.4%; P = 0.29). FMD and NFMD were similar in Asian Indians and Caucasians (5.9% ± 4.1% vs. 5.7% ± 2.6%, P = 0.70; 16.4% ± 8% vs. 14.8% ± 4.1%, P = 0.58, respectively). CONCLUSION Endothelial function in Asian Indian men is not attenuated in comparison to Caucasian men.
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Affiliation(s)
- Snigdha Pusalavidyasagar
- 1 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Minnesota , Minneapolis, Minnesota
| | - Fatima H Sert Kuniyoshi
- 2 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic , Rochester, Minnesota
| | | | - Prachi Singh
- 2 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic , Rochester, Minnesota
| | - Shantal Maharaj
- 2 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic , Rochester, Minnesota
| | - Pavel Leinveber
- 2 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic , Rochester, Minnesota
| | - Jiri Nykodym
- 2 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic , Rochester, Minnesota
| | - Virend K Somers
- 2 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic , Rochester, Minnesota
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Kelley EA, Kandula NR, Kanaya AM, Yen IH. Neighborhood Walkability and Walking for Transport Among South Asians in the MASALA Study. J Phys Act Health 2016; 13:514-9. [PMID: 26529292 PMCID: PMC5070655 DOI: 10.1123/jpah.2015-0266] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The neighborhood built environment can have a strong influence on physical activity levels, particularly walking for transport. In examining racial/ethnic differences in physical activity, one important and understudied group is South Asians. This study aims to describe the association between neighborhood walkability and walking for transport among South Asian men and women in the United States in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. METHODS A cross-sectional study was conducted in 2014 using the baseline dataset of the MASALA study (N = 906). Mean age was 55 years old and 54% of the sample was male. Weekly minutes spent walking for transport was assessed using a questionnaire adapted from the Cross-Cultural Activity Participation Study. Neighborhood walkability was measured using Walk Score, a composite index of walkability. RESULTS After adjusting for covariates, with each 10-point increase in Walk Score, South Asian American men engaged in 13 additional minutes per week of walking for transport (P = .008). No association was observed between walkability and walking for transport in South Asian American women. CONCLUSIONS Results provide new evidence for how the effects of environmental influences on walking for transport may vary between South Asian men and women.
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Affiliation(s)
| | | | - Alka M. Kanaya
- Dept of Medicine, University of California, San Francisco, CA
| | - Irene H. Yen
- Dept of Medicine, University of California, San Francisco, CA
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Ahuja V, Masaki K, Barinas-Mitchell EJM, Rodriguez BL, Althouse AD, Ueshima H, Vishnu A, Seto TB, Kuller LH, Wilcox B, Sekikawa A. Significantly Greater Progression of Intima-Media Thickness of the Carotid Artery in Japanese American Men Than in White Men: The ERA JUMP Study. Can J Cardiol 2016; 32:1246.e7-1246.e12. [PMID: 26947536 DOI: 10.1016/j.cjca.2015.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 12/14/2015] [Accepted: 12/14/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Although a westernized lifestyle was associated with increased coronary heart disease (CHD), morbidity, and mortality in first- and second-generation Japanese Americans, CHD mortality was reported to be lower in this population than in whites. The risk profile of CHD for third- and fourth-generation Japanese Americans is not known. We compared the progression of carotid intima-media thickness (CIMT) between third- or fourth-generation Japanese Americans and whites. METHODS Population-based samples of 473 men (Japanese Americans, 227; whites, 246) aged 40-49 years at baseline and free of clinical cardiovascular disease were examined for CIMT at baseline (2004-2007) and follow-up (2007-2013). CIMT was determined centrally at the University of Pittsburgh, Pittsburgh, Pennsylvania. Analysis of covariance was used to compare annualized progression of CIMT between Japanese Americans and whites, adjusting for cardiovascular risk factors and baseline CIMT. RESULTS Progression of CIMT was significantly greater in Japanese Americans than in whites both before and after adjusting for covariates: mean, 14.4 μm/y; 95% confidence interval [CI],12.3-16.4 vs 9.8 μm/y; 95% CI, 7.8-11.7; P < 0.05 and 15.1 μm/y; 95% CI, 13.1-17.1 vs 9.1 μm/y; 95% CI, 7.2-11.0; P < 0.05, respectively. Age, total cholesterol/high-density lipoprotein cholesterol, and diabetes in Japanese Americans and age, hypertension, and lipid medication in whites were significantly associated with progression of CIMT. CONCLUSIONS The significantly greater progression of CIMT in Japanese Americans than in whites might suggest a higher future burden of CHD in Japanese Americans than in whites. The current study identifies Japanese Americans as an important target group for prevention of CHD. Future research assessing carotid plaque in addition to CIMT is warranted.
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Affiliation(s)
- Vasudha Ahuja
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kamal Masaki
- Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | | | - Beatriz L Rodriguez
- Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Andrew D Althouse
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Research Institute, Pennsylvania, USA
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Abhishek Vishnu
- Department of Biostatistics, West Virginia University, Morgantown, West Virginia, USA
| | - Todd B Seto
- Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bradley Wilcox
- Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Akira Sekikawa
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Pu J, Romanelli R, Zhao B, Azar KMJ, Hastings KG, Nimbal V, Fortmann SP, Palaniappan LP. Dyslipidemia in Special Ethnic Populations. Endocrinol Metab Clin North Am 2016; 45:205-16. [PMID: 26893006 PMCID: PMC7251984 DOI: 10.1016/j.ecl.2015.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortality rates in these groups. Statins may have greater efficacy for Asians, but the data are mixed. Lifestyle modifications are recommended. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.
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Affiliation(s)
- Jia Pu
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA.
| | - Robert Romanelli
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA
| | - Beinan Zhao
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA
| | - Kristen M J Azar
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA
| | - Katherine G Hastings
- Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA
| | - Vani Nimbal
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA
| | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Latha P Palaniappan
- Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA
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Williams NJ, Jean-Louis G, Ravenell J, Seixas A, Islam N, Trinh-Shevrin C, Ogedegbe G. A community-oriented framework to increase screening and treatment of obstructive sleep apnea among blacks. Sleep Med 2016; 18:82-7. [PMID: 26652238 PMCID: PMC4908818 DOI: 10.1016/j.sleep.2015.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 07/22/2015] [Accepted: 07/31/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a leading sleep disorder that is disproportionately more prevalent in minority populations and is a major risk factor for cardiovascular disease (CVD) morbidity and mortality. OSA is associated with many chronic conditions including hypertension, diabetes, and obesity, all of which are disproportionately more prevalent among blacks (ie, peoples of African American, Caribbean, or African descent). METHODS This article reviews studies conducted in the United States (US) that investigated sleep screenings and adherence to treatment for OSA among blacks. In addition, guidelines are provided for implementing a practical framework to increase OSA screening and management among blacks. RESULTS Several studies have documented racial/ethnic disparities in adherence to treatment for OSA. However, despite its public health significance, there is a paucity of studies addressing these disparities. Further, there is a lack of health programs and policies to increase screening and treatment of OSA among blacks and other minority populations. A practical framework to increase the number of blacks who are screened for OSA and treated appropriately is warranted. Such a framework is timely and major importance, as early identification of OSA in this high-risk population could potentially lead to early treatment and prevention of CVD, thereby reducing racial and ethnic disparities in sleep-related CVD morbidity and mortality.
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Affiliation(s)
- Natasha J Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA.
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Joeseph Ravenell
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Azizi Seixas
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Nadia Islam
- Center for Health Equity, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Chau Trinh-Shevrin
- Center for Health Equity, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
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Jones MR, Diez-Roux AV, O’Neill MS, Guallar E, Sharrett AR, Post W, Kaufman JD, Navas-Acien A. Ambient air pollution and racial/ethnic differences in carotid intima-media thickness in the Multi-Ethnic Study of Atherosclerosis (MESA). J Epidemiol Community Health 2015; 69:1191-8. [PMID: 26142402 PMCID: PMC4763882 DOI: 10.1136/jech-2015-205588] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/17/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the USA, ethnic disparities in atherosclerosis persist after accounting for known risk factors. Ambient air pollution is associated with increased levels of atherosclerosis and differs in the USA by race/ethnicity. We estimated the influence of ambient air pollution exposure to ethnic differences in common carotid intima-media thickness (IMT). METHODS We cross-sectionally studied 6347 Caucasian-American, African-American, Hispanic and Chinese adults across 6 US cities in 2000-2002. Annual ambient air pollution concentrations (fine particulate matter [PM2.5] and oxides of nitrogen [NOX]) were estimated at each participant's residence. IMT was assessed by ultrasound. RESULTS The mean IMT was 19.4 and 37.6 μm smaller for Hispanic women and men, 53.6 and 7.1 μm smaller for Chinese women and men, and 23.4 and 38.7 μm higher for African-American women and men compared with Caucasian-American women and men. After adjustment for PM2.5, the differences in IMT remained similar for Hispanic and African-American participants but was even more negative for Chinese participants (mean IMT difference of -58.4 μm for women and -15.7 μm for men) compared with Caucasian-American participants. The IMT difference in Chinese participants compared with Caucasian-American participants related to their higher PM2.5 exposures was 4.8 μm (95% CI 0.2 to 10.8) for women and 8.6 μm (95% CI 3.4 to 15.3) for men. NOX was not related to ethnic differences in IMT. CONCLUSIONS The smaller carotid IMT levels in Chinese participants were even smaller after accounting for higher PM2.5 concentrations in Chinese participants compared with Caucasian-American participants. Air pollution was not related to IMT differences in African-American and Hispanic participants compared with Caucasian-American participants.
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Affiliation(s)
- Miranda R Jones
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana V Diez-Roux
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Marie S O’Neill
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Eliseo Guallar
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Richey Sharrett
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wendy Post
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joel D Kaufman
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Ana Navas-Acien
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ho A, Hameed H, Lee AW, Shih M. Potential Gains in Life Expectancy from Reductions in Leading Causes of Death, Los Angeles County: a Quantitative Approach to Identify Candidate Diseases for Prevention and Burden Disparities Elimination. J Racial Ethn Health Disparities 2015; 3:431-43. [DOI: 10.1007/s40615-015-0156-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/10/2015] [Accepted: 08/06/2015] [Indexed: 11/30/2022]
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Jean-Louis G, Youngstedt S, Grandner M, Williams NJ, Sarpong D, Zizi F, Ogedegbe G. Unequal burden of sleep-related obesity among black and white Americans. Sleep Health 2015; 1:169-176. [PMID: 26937487 DOI: 10.1016/j.sleh.2015.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study ascertained whether individuals of the black race/ethnicity are unequally burdened by sleep-related overweight/obesity. METHODS Analysis was based on data obtained from Americans (ages, 18-85 years) in the National Health Interview Survey (1977-2009). Sleep duration was coded as either very short sleep (VSS) (≤5 hours), short sleep (SS) (5-6 hours), or long sleep (>8 hours), referenced to 7-8-hour sleepers. Overweight was defined as body mass index (BMI) ≥25.0 and ≤29.9 kg/m2 and obesity, BMI ≥30 kg/m2, referenced to normal weight (BMI = 18.5-24.9 kg/m2). RESULTS Multivariate-adjusted regression analyses indicated that, among whites, VSS was associated with a 10% increased likelihood of being overweight and 51% increased likelihood of being obese, relative to 7-8-hour sleepers. Short sleep was associated with a 13% increased likelihood of being overweight and 45% increased likelihood of being obese. Long sleep was associated with 21% increased likelihood of being obese. Among blacks, VSS was associated with a 76% increased likelihood of being overweight and 81% increased likelihood of being obese. Short sleep was associated with a 16% increased likelihood of being overweight and 32% increased likelihood of being obese. As for the white stratum, long sleep was associated with a 25% increased likelihood of being obese. CONCLUSION Our investigation demonstrates strong linkages between inadequate sleep and overweight/ obesity among black and white Americans. Although it cannot be said that insufficient sleep causes overweight/obesity, individuals of the black race/ethnicity sleeping ≤5 hours may be unequally burdened by sleep-related overweight/obesity.
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Affiliation(s)
- Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY
| | - Shawn Youngstedt
- College of Nursing and Health Innovation, College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Michael Grandner
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Natasha J Williams
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY
| | - Daniel Sarpong
- Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans, LA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY
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Gijsberts CM, Seneviratna A, Hoefer IE, Agostoni P, Rittersma SZH, Pasterkamp G, Hartman M, Pinto de Carvalho L, Richards AM, Asselbergs FW, de Kleijn DPV, Chan MY. Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients. PLoS One 2015; 10:e0131977. [PMID: 26147437 PMCID: PMC4492790 DOI: 10.1371/journal.pone.0131977] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic "synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery" (SYNTAX) score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays. METHODS We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians) and Singapore (Chinese, Indians and Malays). Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI). We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality. RESULTS Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001. Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30) occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02). CONCLUSION Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians, independent of SYNTAX score.
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Affiliation(s)
- Crystel M. Gijsberts
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, the Netherlands
| | | | - Imo E. Hoefer
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Leonardo Pinto de Carvalho
- Cardiac Department, National University Hospital, Singapore
- Department of Cardiology, Albert Einstein Hospital, Sao Paulo, Brazil
| | - A. Mark Richards
- Cardiac Department, National University Hospital, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
| | - Folkert W. Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
- Institute of Cardiovascular Science, faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Dominique P. V. de Kleijn
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, the Netherlands
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
| | - Mark Y. Chan
- Cardiac Department, National University Hospital, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
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Fernando E, Razak F, Lear SA, Anand SS. Cardiovascular Disease in South Asian Migrants. Can J Cardiol 2015; 31:1139-50. [PMID: 26321436 DOI: 10.1016/j.cjca.2015.06.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 02/09/2023] Open
Abstract
Cardiovascular disease (CVD) represents a significant cause of global mortality and morbidity. South Asians (SAs) have a particularly high burden of coronary artery disease (CAD). This review describes current literature regarding the prevalence, incidence, etiology, and prognosis of CVD in SA migrants to high-income nations. We conducted a narrative review of CVD in the SA diaspora through a search of MEDLINE and PubMed. We included observational studies, randomized clinical trials, nonsystematic reviews, systematic reviews, and meta-analyses written in English. Of 15,231 articles identified, 827 articles were screened and 124 formed the basis for review. SA migrants have a 1.5-2 times greater prevalence of CAD than age- and sex-adjusted Europids. Increased abdominal obesity and body fat and increased burden of type 2 diabetes mellitus and dyslipidemia appear to be primary drivers of the excess CAD burden in SAs. Sedentary lifestyle and changes in diet after immigration are important contributors to weight gain and adiposity. Early life factors, physical activity patterns and, in some cases, reduced adherence to medical therapy may contribute to increased CVD risks in SAs. Novel biomarkers like leptin and adipokines may show distinct patterns in SAs and provide insights into cardiometabolic risk determinants. In conclusion, SAs have distinct CVD risk predispositions, with a complex relationship to cultural, innate, and acquired factors. Although CVD risk factor management and treatment among SAs is improving, opportunities exist for further advances.
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Affiliation(s)
- Eshan Fernando
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Harvard Center for Population and Development Studies, Boston, Massachusetts, USA
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Epidemiology, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada.
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Inohara T, Kohsaka S, Goto M, Furukawa Y, Fukushima M, Sakata R, Elayda M, Wilson JM, Kimura T. Hypothesis of Long-Term Outcome after Coronary Revascularization in Japanese Patients Compared to Multiethnic Groups in the US. PLoS One 2015; 10:e0128252. [PMID: 26023784 PMCID: PMC4449105 DOI: 10.1371/journal.pone.0128252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ethnicity has a significant impact on coronary artery disease (CAD). This study investigated the long-term outcomes of Japanese patients undergoing revascularization compared with US patients belonging to multiple ethnic groups. METHODS AND RESULTS We evaluated clinical outcomes, based on ethnicity, of patients included in the Coronary Revascularization Demonstrating Outcome (CREDO-Kyoto) and the Texas (US) Heart Institute Research Database (THIRDBase) registries. For the analysis, we included 8871 patients from the CREDO-Kyoto registry (median follow-up period [FU], 3.5 years; interquartile range [IQR], 2.6-4.3) and 6717 patients from the THIRDBase registry (FU, 5.2 years; IQR, 3.8-6.5) who underwent percutaneous coronary intervention or bypass surgery. Cox proportional hazard models were constructed to compare the adjusted long-term outcomes for each ethnic group. A total of 8871 Japanese, 5170 Caucasians, 648 African-Americans, 817 Hispanics, and 82 Asian-Americans were identified. When adjusted, Japanese patients had significantly better outcomes than US patients, classified by ethnicity (Caucasians: hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.35-1.79; Hispanics: HR, 1.53; 95% CI, 1.22-1.93; African-Americans: HR, 2.03; 95% CI, 1.62-2.56), except for Asian-Americans (HR, 0.84; 95% CI. 0.38-1.89) who had outcomes similar to Japanese patients. CONCLUSION Our findings indicate better survival outcomes in re-vascularized Japanese CAD patients compared to major ethnic groups in the US, including Caucasian, Hispanic, and African-American CAD patients. The characteristics and outcomes of Japanese CAD patients were similar to those of Asian-Americans, despite the sample size limitations in the US dataset.
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Affiliation(s)
- Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- * E-mail:
| | | | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - MacArthur Elayda
- Division of Biostatistics, Texas Heart Institute at Baylor St. Luke’s Medical Center, Houston, Texas, United States of America
| | - James M. Wilson
- Division of Cardiology, Texas Heart Institute at Baylor St. Luke’s Medical Center, Houston, Texas, United States of America
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Pu J, Romanelli R, Zhao B, Azar KMJ, Hastings KG, Nimbal V, Fortmann SP, Palaniappan LP. Dyslipidemia in special ethnic populations. Cardiol Clin 2015; 33:325-33. [PMID: 25939303 PMCID: PMC4421090 DOI: 10.1016/j.ccl.2015.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortality rates in these groups. Statins may have greater efficacy for Asians, but the data are mixed. Lifestyle modifications are recommended. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.
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Affiliation(s)
- Jia Pu
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA.
| | - Robert Romanelli
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA
| | - Beinan Zhao
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA
| | - Kristen M J Azar
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA
| | - Katherine G Hastings
- Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA
| | - Vani Nimbal
- Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA 94301, USA
| | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Latha P Palaniappan
- Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA
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Zhao B, Jose PO, Pu J, Chung S, Ancheta IB, Fortmann SP, Palaniappan LP. Racial/ethnic differences in hypertension prevalence, treatment, and control for outpatients in northern California 2010-2012. Am J Hypertens 2015; 28:631-9. [PMID: 25352230 PMCID: PMC4462650 DOI: 10.1093/ajh/hpu189] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Hypertension (HTN) is a known major cardiovascular disease risk factor, but prevalence, treatment, and control of HTN among rapidly growing minority groups such as Asian Americans and Hispanics are unknown largely due to either underrepresentation in epidemiologic studies or aggregation of Asian American subgroups. METHODS A three-year cross-section (2010-2012) of patients from a large ambulatory care setting in northern California was examined in the following subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Mexicans, non-Hispanic Blacks (NHBs), and non-Hispanic Whites (NHWs). We defined HTN as two separate nonemergent office visit blood pressure measurements ≥140/90 mm Hg, physician diagnosis of HTN, or use of antihypertensive medications. RESULTS A total of 208,985 patients were included in the study. Age-adjusted HTN prevalence ranged from 30.0% in Chinese women to 59.9% in Filipino men. Most minority subgroups had lower or similar odds of having HTN compared with NHWs, except for Filipinos and NHBs whose odds were significantly higher after adjusting for patient demographic and clinical characteristics. Asian Americans and NHBs were more likely to be treated for HTN compared with NHWs. Achievement of blood pressure control was lower among Filipino women (odds ratio = 0.82, 99% confidence interval 0.70-0.96) and NHB men (odds ratio = 0.73, 99% confidence interval 0.58-0.91), compared with NHW women and men. CONCLUSIONS Substantial racial/ethnic variation in HTN prevalence, treatment, and control was found in our study population. Filipino and NHB women and men are at especially high risk for HTN and may have more difficulty in achieving adequate blood pressure control.
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Affiliation(s)
- Beinan Zhao
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Powell O Jose
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Jia Pu
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Irma B Ancheta
- Department of Medicine-Jacksonville, University of Florida, Jacksonville, Florida, USA
| | | | - Latha P Palaniappan
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA;
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Hastings KG, Jose PO, Kapphahn KI, Frank ATH, Goldstein BA, Thompson CA, Eggleston K, Cullen MR, Palaniappan LP. Leading Causes of Death among Asian American Subgroups (2003-2011). PLoS One 2015; 10:e0124341. [PMID: 25915940 PMCID: PMC4411112 DOI: 10.1371/journal.pone.0124341] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Our current understanding of Asian American mortality patterns has been distorted by the historical aggregation of diverse Asian subgroups on death certificates, masking important differences in the leading causes of death across subgroups. In this analysis, we aim to fill an important knowledge gap in Asian American health by reporting leading causes of mortality by disaggregated Asian American subgroups. METHODS AND FINDINGS We examined national mortality records for the six largest Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and non-Hispanic Whites (NHWs) from 2003-2011, and ranked the leading causes of death. We calculated all-cause and cause-specific age-adjusted rates, temporal trends with annual percent changes, and rate ratios by race/ethnicity and sex. Rankings revealed that as an aggregated group, cancer was the leading cause of death for Asian Americans. When disaggregated, there was notable heterogeneity. Among women, cancer was the leading cause of death for every group except Asian Indians. In men, cancer was the leading cause of death among Chinese, Korean, and Vietnamese men, while heart disease was the leading cause of death among Asian Indians, Filipino and Japanese men. The proportion of death due to heart disease for Asian Indian males was nearly double that of cancer (31% vs. 18%). Temporal trends showed increased mortality of cancer and diabetes in Asian Indians and Vietnamese; increased stroke mortality in Asian Indians; increased suicide mortality in Koreans; and increased mortality from Alzheimer's disease for all racial/ethnic groups from 2003-2011. All-cause rate ratios revealed that overall mortality is lower in Asian Americans compared to NHWs. CONCLUSIONS Our findings show heterogeneity in the leading causes of death among Asian American subgroups. Additional research should focus on culturally competent and cost-effective approaches to prevent and treat specific diseases among these growing diverse populations.
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Affiliation(s)
- Katherine G. Hastings
- Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America
| | - Powell O. Jose
- Sutter Health Medical Foundation, Department of Cardiology, Davis, California, United States of America
| | - Kristopher I. Kapphahn
- Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America
| | - Ariel T. H. Frank
- Columbia University School of Nursing, New York, New York, United States of America
| | - Benjamin A. Goldstein
- Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America
| | - Caroline A. Thompson
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, United States of America
| | - Karen Eggleston
- Stanford University, Shorenstein Asia-Pacific Research Center, Stanford, California, United States of America
| | - Mark R. Cullen
- Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America
| | - Latha P. Palaniappan
- Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America
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Qian F, Fonarow GC, Krim SR, Vivo RP, Cox M, Hannan EL, Shaw BA, Hernandez AF, Eapen ZJ, Yancy CW, Bhatt DL. Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program. Int J Cardiol 2015; 189:141-7. [PMID: 25889445 DOI: 10.1016/j.ijcard.2015.03.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/26/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program. METHODS We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program (2005-2012). Baseline characteristics, quality of care metrics, in-hospital mortality, discharge to home, and length of stay were examined. RESULTS Relative to white patients, Asian-American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency, but similar ejection fraction. Overall, Asian-American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk <RR>, 0.88; 95% confidence interval <CI>, 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Compared with white patients, Asian-American patients had comparable risk adjusted in-hospital mortality (RR, 1.11; 95% CI, 0.91-1.35), length of stay>4 days (RR, 1.01; 95% CI, 0.95-1.08), and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11). CONCLUSIONS Despite some differences in clinical profiles, Asian-American patients hospitalized with HF receive very similar quality of care and have comparable health outcomes to their white counterparts.
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Affiliation(s)
- Feng Qian
- University at Albany-State University of New York, Albany, United States.
| | - Gregg C Fonarow
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, United States
| | - Selim R Krim
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Rey P Vivo
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, United States
| | | | - Edward L Hannan
- University at Albany-State University of New York, Albany, United States
| | - Benjamin A Shaw
- University at Albany-State University of New York, Albany, United States
| | | | | | | | - Deepak L Bhatt
- VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
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Shah A, Clayman ML, Glass S, Kandula NR. Protect your heart: a culture-specific multimedia cardiovascular health education program. JOURNAL OF HEALTH COMMUNICATION 2015; 20:424-430. [PMID: 25647363 PMCID: PMC4834216 DOI: 10.1080/10810730.2014.965366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
South Asians, the second fastest growing racial/ethnic minority in the United States, have high rates of coronary heart disease. Few coronary heart disease prevention efforts target this population. The authors developed and tested a culture-specific, multimedia coronary heart disease prevention education program in English and Hindi for South Asians. Participants were recruited from community organizations in Chicago, Illinois, between June and October of 2011. Bilingual interviewers used questionnaires to assess participants' knowledge and perceptions before and after the patient education program. The change from pretest score to posttest score was calculated using a paired t test. Linear regression was used to determine the association between posttest scores and education and language. Participants' (N = 112) average age was 41 years, 67% had more than a high school education, and 50% spoke Hindi. Participants' mean pretest score was 15 (SD = 4). After the patient education program, posttest scores increased significantly among all participants (posttest score = 24, SD = 4), including those with limited English proficiency. Lower education was associated with a lower posttest score (β = -2.2, 95% CI [-0.68, -3.83]) in adjusted regression. A culture-specific, multimedia patient education program significantly improved knowledge and perceptions about coronary heart disease prevention among South Asian immigrants. Culturally salient multimedia education may be an effective and engaging way to deliver health information to diverse patient populations.
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Affiliation(s)
- Amy Shah
- a Department of Community Health Sciences, School of Public Health , University of Illinois , Chicago , Illinois , USA
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Gao F, Lam CSP, Sim LL, Koh TH, Foo D, Ong HY, Tong KL, Tan HC, Machin D, Wong KS, Chan MYY, Chua TSJ. Impact of the joint association between sex, age and diabetes on long-term mortality after acute myocardial infarction. BMC Public Health 2015; 15:308. [PMID: 25885528 PMCID: PMC4423520 DOI: 10.1186/s12889-015-1612-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of sex, and its joint effect with age and diabetes mellitus, on mortality subsequent to surviving an acute myocardial infarction (AMI) beyond 30 days are unclear. The high prevalence of diabetes mellitus in an ethnically diverse Asian population motivates this study. METHODS The study population comprised of a nationwide cohort of Asian patients with AMI, hospitalized between 2000 to 2005, who survived the first 30 days post-admission and were followed prospectively until death or 12 years. RESULTS Among the 13,389 survivors, there were fewer women (25.5%) who were older than men (median 70 vs. 58 years) and a larger proportion had diabetes mellitus at admission (51.4% vs. 31.4%). During follow-up 4,707 deaths (women 13.2%; men 22.0%) occurred, with women experiencing higher mortality than men with an averaged hazard ratio (HR): 2.08; 95% confidence interval : 1.96-2.20. However the actual adverse outcome, although always greater, reduced over time with an estimated HR: 2.23 (2.04-2.45) at 30 days to HR: 1.75; (1.47-2.09) 12 years later. The difference in mortality also declined with increasing age: HR 1.80 (1.52-2.13) for those aged 22-59, 1.26 (1.11-1.42) for 60-69, 1.06 (0.96-1.17) and 0.96 (0.85-1.09) for those 70-79 and 80-101 years. Significant two-factor interactions were observed between sex, age and diabetes (P < 0.001). Diabetic women <60 years of age had greater mortality than diabetic men of the same age (adjusted HR: 1.44; 1.14-1.84; P = 0.003), while diabetic women and men ≥60 years of age had a less pronounced mortality difference (adjusted HR: 1.12; 0.99-1.26). CONCLUSIONS One in two women hospitalized for AMI in this Asian cohort had diabetes and the sex disparity in post-MI mortality was most pronounced among these who were <60 years of age. This underscores the need for better secondary prevention in this high-risk group.
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Affiliation(s)
- Fei Gao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Carolyn Su Ping Lam
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
| | - Ling Ling Sim
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
| | - Tian Hai Koh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
| | - David Foo
- Cardiac Department, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Hean Yee Ong
- Khoo Teck Puat Hospital, 378 Alexandra Road, Singapore, 159964, Singapore.
| | - Khim Leng Tong
- Changi General Hospital, Simei Street 3, Singapore, 529889, Singapore.
| | - Huay Cheem Tan
- National University Heart Centre Singapore, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - David Machin
- Medical Statistics Group, School of Health and Related Sciences, University of Sheffield, Regents Court, 30 Regent Street, Sheffield, S1 4DA, UK. .,Department of Cancer Studies and Molecular Medicine, Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary, Leicester, LE2 7LX, UK.
| | - Kok Seng Wong
- Singapore General Hospital, 1 Hospital Drive, Singapore, 169608, Singapore.
| | - Mark Yan Yee Chan
- National University Heart Centre Singapore, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Racial Differences in the Ability of Subclinical Atherosclerosis Testing to Predict CVD. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0453-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sarwar E, Arias D, Becerra BJ, Becerra MB. Sociodemographic Correlates of Dietary Practices among Asian-Americans: Results from the California Health Interview Survey. J Racial Ethn Health Disparities 2015; 2:494-500. [PMID: 26863555 DOI: 10.1007/s40615-015-0097-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 02/09/2015] [Accepted: 02/27/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies show that Asian-American subgroups do not always meet dietary recommendations and are at high risk of cardiovascular diseases. The purpose of our research is to illustrate the various sociodemographic correlates of dietary habits for six subgroups of Asian-Americans in California. DESIGN The 2005 California Health Interview Survey (CHIS) was utilized. A total of 3772 Asian-Americans were included in this study, with the largest subgroup being Chinese (n = 1280; N = 913,798). The outcome variable for this study was dietary behavior defined as consuming five or more fruits and vegetables per day (5-a-day), provided by CHIS. Univariate and multivariable regression analyses were conducted accounting for complex survey design. RESULTS Being a female (Chinese, Filipina, Korean, and Vietnamese), not being married (Chinese), not being a college graduate (Chinese), living in poverty (South Asian), and speaking only English language at home (Chinese and Japanese) were associated with higher odds of not meeting a 5-a-day requirement. CONCLUSION Results highlighted several sociodemographic correlates to not meeting 5-a-day requirement among six Asian-American subgroups. Targeted health promotion measures for such at-risk groups should be implemented to improve dietary practices.
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Affiliation(s)
- Evangel Sarwar
- Department of Health Science and Human Ecology, California State University, 5500 University Parkway, San Bernardino, CA, 92407, USA.
| | - Devin Arias
- Department of Health Science and Human Ecology, California State University, 5500 University Parkway, San Bernardino, CA, 92407, USA.
| | | | - Monideepa Bhattacharya Becerra
- Department of Health Science and Human Ecology, California State University, 5500 University Parkway, San Bernardino, CA, 92407, USA.
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de Souza RJ, Anand SS. Cardiovascular disease in Asian Americans: unmasking heterogeneity. J Am Coll Cardiol 2015; 64:2495-7. [PMID: 25500234 DOI: 10.1016/j.jacc.2014.09.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 09/19/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Russell J de Souza
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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90
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Jose PO, Frank ATH, Kapphahn KI, Goldstein BA, Eggleston K, Hastings KG, Cullen MR, Palaniappan LP. Cardiovascular disease mortality in Asian Americans. J Am Coll Cardiol 2014; 64:2486-94. [PMID: 25500233 PMCID: PMC4274749 DOI: 10.1016/j.jacc.2014.08.048] [Citation(s) in RCA: 223] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 08/19/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Asian Americans are a rapidly growing racial/ethnic group in the United States. Our current understanding of Asian-American cardiovascular disease mortality patterns is distorted by the aggregation of distinct subgroups. OBJECTIVES The purpose of the study was to examine heart disease and stroke mortality rates in Asian-American subgroups to determine racial/ethnic differences in cardiovascular disease mortality within the United States. METHODS We examined heart disease and stroke mortality rates for the 6 largest Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) from 2003 to 2010. U.S. death records were used to identify race/ethnicity and cause of death by International Classification of Diseases-10th revision coding. Using both U.S. Census data and death record data, standardized mortality ratios (SMRs), relative SMRs (rSMRs), and proportional mortality ratios were calculated for each sex and ethnic group relative to non-Hispanic whites (NHWs). RESULTS In this study, 10,442,034 death records were examined. Whereas NHW men and women had the highest overall mortality rates, Asian Indian men and women and Filipino men had greater proportionate mortality burden from ischemic heart disease. The proportionate mortality burden of hypertensive heart disease and cerebrovascular disease, especially hemorrhagic stroke, was higher in every Asian-American subgroup compared with NHWs. CONCLUSIONS The heterogeneity in cardiovascular disease mortality patterns among diverse Asian-American subgroups calls attention to the need for more research to help direct more specific treatment and prevention efforts, in particular with hypertension and stroke, to reduce health disparities for this growing population.
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Affiliation(s)
- Powell O Jose
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Ariel T H Frank
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | | | | | - Karen Eggleston
- Stanford University Shorenstein Asia-Pacific Research Center, Stanford, California
| | | | - Mark R Cullen
- Stanford University School of Medicine, Stanford, California
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91
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Panduranga P, Sulaiman KJ, Al-Zakwani I, Alhabib KF, Hersi A, Suwaidi JA, Alsheikh-Ali AA, Almahmeed W, Saif SA, Al-Faleh H, Al-Lawati J, Asaad N, Al-Motarreb A, Amin H. Acute Coronary Syndrome in Indian Subcontinent Patients Residing in the Middle East: Results From Gulf Registry of Acute Coronary Events II. Angiology 2014; 66:818-25. [PMID: 25381144 DOI: 10.1177/0003319714556812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We compared baseline characteristics, clinical presentation, and in-hospital outcomes between Middle Eastern Arabs and Indian subcontinent patients presenting with acute coronary syndrome (ACS). Of the 7930 patients enrolled in Gulf Registry of Acute Coronary Events II (RACE II), 23% (n = 1669) were from the Indian subcontinent. The Indian subcontinent patients, in comparison with the Middle Eastern Arabs, were younger (49 vs 60 years; P < .001), more were males (96% vs 80%; P < .001), had lower proportion of higher Global Registry of Acute Coronary Events risk score (8% vs 27%; P < .001), and less likely to be associated with diabetes (34% vs 42%; P < .001), hypertension (36% vs 51%; P < .001), and hyperlipidemia (29% vs 39%; P < .001) but more likely to be smokers (55% vs 29%; P < .001). After multivariable adjustment, the Middle Eastern Arabs were less likely to be associated with in-hospital congestive heart failure (odds ratio [OR], 0.65; 95% confidence interval [CI]: 0.50-0.86; P = .003) but more likely to be associated with recurrent ischemia (OR 1.33; 95% CI: 1.03-1.71; P = .026) when compared to the Indian subcontinent patients. Despite the baseline differences, there were largely no significant differences in in-hospital outcomes between the Indians and the Middle Eastern Arabs.
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Affiliation(s)
| | | | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman Gulf Health Research, Muscat, Oman
| | - Khalid F Alhabib
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Hersi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jassim Al Suwaidi
- Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital & Weill Cornell Medical College, Doha, Qatar
| | - Alawi A Alsheikh-Ali
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, MA, USA
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | | | - Hussam Al-Faleh
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jawad Al-Lawati
- Non-Communicable Diseases Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Nidal Asaad
- Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital & Weill Cornell Medical College, Doha, Qatar
| | | | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Bahrain
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Kandula NR, Kanaya AM, Liu K, Lee JY, Herrington D, Hulley SB, Persell SD, Lloyd-Jones DM, Huffman MD. Association of 10-year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. J Am Heart Assoc 2014; 3:e001117. [PMID: 25277669 PMCID: PMC4323809 DOI: 10.1161/jaha.114.001117] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Ten‐year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry. Methods and Results South Asians (n=893) from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study who were 40 to 79 years and free of ASCVD were included. Ten‐year ASCVD predicted risk was calculated using the 2013 Pooled Cohort Equations. Lifetime predicted risk was based on risk factor burden. Baseline levels of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima media thickness [CIMT]) were compared across 10‐year and lifetime risk strata: (1) high (≥7.5%) 10‐year and low (<7.5%) 10‐year risk; (2) high (≥39%) lifetime and low (<39%) lifetime risk. South Asian men and women with high 10‐year predicted risk had a significantly greater CAC burden than those with low 10‐year risk. South Asians with high lifetime predicted risk had a significantly increased odds for CAC higher than 0 (odds ratio: men 1.97; 95% CI, 1.2 to 3.2; women 3.14; 95% CI, 1.5, 6.6). Associations between risk strata and CIMT were also present. Conclusion This study is the first to provide evidence that contemporary ASCVD risk assessment algorithms derived from non‐Hispanic white and African‐American samples can successfully identify substantial differences in atherosclerotic burden in US South Asians.
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Affiliation(s)
- Namratha R Kandula
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | - Alka M Kanaya
- University of California, San Francisco, CA (A.M.K., S.B.H.)
| | - Kiang Liu
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | - Ji Young Lee
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | | | | | - Stephen D Persell
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | - Donald M Lloyd-Jones
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | - Mark D Huffman
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
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93
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Nie JX, Ardern CI. Association between obesity and cardiometabolic health risk in Asian-Canadian sub-groups. PLoS One 2014; 9:e107548. [PMID: 25222283 PMCID: PMC4164624 DOI: 10.1371/journal.pone.0107548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/13/2014] [Indexed: 01/26/2023] Open
Abstract
Objectives To quantify and compare the association between the World Health Organizations’ Asian-specific trigger points for public health action [‘increased risk’: body mass index (BMI) ≥23 kg/m2, and; ‘high risk’: BMI ≥27.5 kg/m2] with self-reported cardiovascular-related conditions in Asian-Canadian sub-groups. Methods Six cycles of the Canadian Community Health Survey (2001–2009) were pooled to examine BMI and health in Asian sub-groups (South Asians, Chinese, Filipino, Southeast Asians, Arabs, West Asians, Japanese and Korean; N = 18 794 participants, ages 18–64 y). Multivariable logistic regression, adjusting for demographic, lifestyle characteristics and acculturation measures, was used to estimate the odds of cardiovascular-related health (high blood pressure, heart disease, diabetes, ‘at least one cardiometabolic condition’) outcomes across all eight Asian sub-groups. Results Compared to South Asians (OR = 1.00), Filipinos had higher odds of having ‘at least one cardiometabolic condition’ (OR = 1.29, 95% CI: 1.04–1.62), whereas Chinese (0.63, 0.474–0.9) and Arab-Canadians had lower odds (0.38, 0.28–0.51). In ethnic-specific analyses (with ‘acceptable’ risk weight as the referent), ‘increased’ and ‘high’ risk weight categories were the most highly associated with ‘at least one cardiometabolic condition’ in Chinese (‘increased’: 3.6, 2.34–5.63; ‘high’: 8.9, 3.6–22.01). Compared to normal weight South Asians, being in the ‘high’ risk weight category in all but the Southeast Asian, Arab, and Japanese ethnic groups was associated with approximately 3-times the likelihood of having ‘at least one cardiometabolic condition’. Conclusion Differences in the association between obesity and cardiometabolic health risks were seen among Asian sub-groups in Canada. The use of WHO’s lowered Asian-specific BMI cut-offs identified obesity-related risks in South Asian, Filipino and Chinese sub-groups that would have been masked by traditional BMI categories. These findings have implications for public health messaging, especially for ethnic groups at higher odds of obesity-related health risks.
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Affiliation(s)
- Jason X. Nie
- School of Kinesiology and Health Science, York University, Bethune College, Toronto, Ontario, Canada
| | - Chris I. Ardern
- School of Kinesiology and Health Science, York University, Bethune College, Toronto, Ontario, Canada
- * E-mail:
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Medina-Inojosa J, Jean N, Cortes-Bergoderi M, Lopez-Jimenez F. The Hispanic paradox in cardiovascular disease and total mortality. Prog Cardiovasc Dis 2014; 57:286-92. [PMID: 25246267 DOI: 10.1016/j.pcad.2014.09.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Health statistics and epidemiologic studies have shown that Hispanics live longer than Non Hispanic Whites, despite a high prevalence of cardiovascular disease (CVD) risk factors and an average low socioeconomic status, both strong predictors of CVD and mortality. This phenomenon has been dubbed "The Hispanic paradox" and has been demonstrated in old and contemporary cohorts. To date, no factor has been identified that could explain this phenomenon, but socio demographic factors, dietary intake and genetic predisposition have been proposed as possible explanations for the Hispanic paradox. As with the French paradox, where French were found to have a lower rate of coronary heart disease (CHD), helped to identify the role of the Mediterranean diet and wine consumption in the prevention of CHD, the Hispanic paradox could help identify protective factors against CHD. This article describes the current evidence supporting the existence of the Hispanic paradox and provides a brief review on the possible explanations.
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Affiliation(s)
- Jose Medina-Inojosa
- Division of Cardiovascular Diseases, 200 First Street S.W. Rochester, MN 55905.
| | - Nathalie Jean
- Division of Cardiovascular Diseases, 200 First Street S.W. Rochester, MN 55905.
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Abstract
South Asians (SAs), in their countries or after migration, are at high risk of coronary artery disease (CAD) and mortality compared to other ethnic groups. It has been shown that >90% of CAD global risk could be attributed to 9 modifiable risk factors (RFs) worldwide. However, these conventional RFs may not fully explain this high risk of CAD among SAs. Therefore, attention has been directed toward nonconventional RFs. In this narrative review, we evaluate the conventional and emerging cardiovascular RFs characterizing SAs. These factors may explain the high morbidity and mortality among SAs. Further prospective studies are urgently needed to set algorithms for the optimal management of these RFs in high-risk populations like SAs.
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Affiliation(s)
- Emad Ahmed
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Cardiology Department, National Heart Institute, Cairo, Egypt
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- Clinical Research, Hamad General Hospital, Doha, Qatar
- Cardiology Unit, Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
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96
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Kanaya AM, Kandula NR, Ewing SK, Herrington D, Liu K, Blaha MJ, Srivastava S, Dave SS, Budoff MJ. Comparing coronary artery calcium among U.S. South Asians with four racial/ethnic groups: the MASALA and MESA studies. Atherosclerosis 2014; 234:102-7. [PMID: 24632509 PMCID: PMC4005416 DOI: 10.1016/j.atherosclerosis.2014.02.017] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/08/2014] [Accepted: 02/14/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES South Asians (individuals from India, Pakistan, Bangladesh, Nepal, and Sri Lanka) have high rates of cardiovascular disease which cannot be explained by traditional risk factors. Few studies have examined coronary artery calcium (CAC) in South Asians. METHODS We created a community-based cohort of South Asians in the United States and compared the prevalence and distribution of CAC to four racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA). We compared 803 asymptomatic South Asians free of cardiovascular disease to the four MESA racial/ethnic groups (2622 Whites, 1893 African Americans, 1496 Latinos and 803 Chinese Americans). RESULTS The age-adjusted prevalence of any CAC was similar between White and South Asian men, but was lower in South Asian women compared to White women. After adjusting for all covariates associated with CAC, South Asian men were similar to White men and had higher CAC scores compared to African Americans, Latinos and Chinese Americans. In fully adjusted models, CAC scores were similar for South Asian women compared to all women enrolled in MESA. However, South Asian women ≥70 years had a higher prevalence of any CAC than most other racial/ethnic groups. CONCLUSIONS South Asian men have similarly high CAC burden as White men, but higher CAC than other racial/ethnic groups. South Asian women appear to have similar CAC burden compared to other women, but have somewhat higher CAC burden in older age. The high burden of subclinical coronary atherosclerosis in South Asians may partly explain higher rates of cardiovascular disease in South Asians.
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Affiliation(s)
- Alka M Kanaya
- University of California, San Francisco, United States.
| | | | - Susan K Ewing
- University of California, San Francisco, United States
| | | | - Kiang Liu
- Northwestern University, United States
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, United States
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98
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de Carvalho LP, Gao F, Chen Q, Hartman M, Sim LL, Koh TH, Foo D, Chin CT, Ong HY, Tong KL, Tan HC, Yeo TC, Yew CK, Richards AM, Peterson ED, Chua T, Chan MY. Differences in late cardiovascular mortality following acute myocardial infarction in three major Asian ethnic groups. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 3:354-62. [PMID: 24598820 DOI: 10.1177/2048872614527007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM the purpose of this study was to investigate differences in long-term mortality following acute myocardial infarction (AMI) in patients from three major ethnicities of Asia. METHODS AND RESULTS We studied 15,151 patients hospitalized for AMI with a median follow-up of 7.3 years (maximum 12 years) in six publicly-funded hospitals in Singapore from 2000-2005. Overall and cause-specific cardiovascular (CV) mortality until 2012 were compared among three major ethnic groups that represent large parts of Asia: Chinese, Malay and Indian. Relative survival of all three ethnic groups was compared with a contemporaneous background reference population using the relative survival ratio (RSR) method. The median global registry of acute coronary events score was highest among Chinese, followed by Malay and Indians: 144 (25th percentile 119, 75th percentile 173), 138 (115, 167), and 131 (109, 160), respectively, p<0.0001; similarly, in-hospital mortality was highest among Chinese (9.8%) followed by Malay (7.6%) and Indian (6.4%) patients. In contrast, 12-year overall and cause-specific CV mortality was highest among Malay (46.2 and 32.0%) followed by Chinese (43.0 and 27.0%) and Indian (35.9 and 25.2%) patients, p<0.0001. The five-year RSR was lowest among Malay (RSR 0.69) followed by Chinese (RSR 0.73) and Indian (RSR 0.79) patients, compared with a background reference population (RSR 1.00). CONCLUSIONS We observed strong inter-Asian ethnic disparities in long-term mortality after AMI. Malay patients had the most discordant relationship between baseline risk and long-term mortality. Intensified interventions targeting Malay patients as a high-risk group are necessary to reduce disparities in long-term outcomes.
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Affiliation(s)
| | - Fei Gao
- National Heart Centre, Singapore Duke-NUS Graduate Medical School, Singapore
| | | | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore Department of Surgery, National University of Singapore, Singapore
| | | | | | | | | | | | | | - Huay-Cheem Tan
- National University Heart Centre, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- National University Heart Centre, National University of Singapore, Singapore
| | - Chow-Khuan Yew
- National Registry of Disease Office, Health Promotion Board, Singapore
| | - Arthur M Richards
- National University Heart Centre, National University of Singapore, Singapore
| | | | | | - Mark Y Chan
- National University Heart Centre, National University of Singapore, Singapore
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Frank ATH, Zhao B, Jose PO, Azar KMJ, Fortmann SP, Palaniappan LP. Racial/ethnic differences in dyslipidemia patterns. Circulation 2014; 129:570-9. [PMID: 24192801 PMCID: PMC4212818 DOI: 10.1161/circulationaha.113.005757] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND No studies have comprehensively examined the prevalence of dyslipidemia, a major risk factor for cardiovascular disease, among diverse racial/ethnic minority groups. The primary aim of this study was to identify racial/ethnic differences in dyslipidemia among minorities including Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, or Vietnamese), Mexican Americans, and blacks compared with non-Hispanic whites. METHODS AND RESULTS Using a 3-year cross section (2008-2011), we identified 169 430 active primary care patients (35 years or older) from an outpatient healthcare organization in northern California. Age-standardized prevalence rates were calculated for 3 dyslipidemia subtypes: high triglycerides (fasting laboratory value ≥150 mg/dL), low levels of high-density lipoprotein cholesterol (fasting laboratory value <40 mg/dL [men] and <50 mg/dL [women]), and high levels of low-density lipoprotein cholesterol (fasting laboratory value ≥130 mg/dL or taking low-density lipoprotein-lowering agents). Odds ratios were calculated by multivariable logistic regression, with adjustment for patient characteristics (age, measured body mass index, smoking). Compared with non-Hispanic whites, every minority subgroup had an increased prevalence of high triglycerides except blacks. Most minority groups had an increased prevalence of low high-density lipoprotein cholesterol, except for Japanese and blacks. The prevalence of high low-density lipoprotein cholesterol was increased among Asian Indians, Filipinos, Japanese, and Vietnamese compared with non-Hispanic whites. CONCLUSIONS Minority groups, except for blacks, were more likely to have high triglyceride/low high-density lipoprotein cholesterol dyslipidemia. Further research is needed to determine how racial/ethnic differences in dyslipidemia affect racial/ethnic differences in cardiovascular disease rates.
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Affiliation(s)
- Ariel T H Frank
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA (A.T.H.F., B.Z., P.O.J., K.M.J.A., L.P.P.) and Kaiser Permanente Center for Health Research Northwest, Portland, OR (S.P.F.)
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100
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Gadgil MD, Anderson CAM, Kandula NR, Kanaya AM. Dietary patterns in Asian Indians in the United States: an analysis of the metabolic syndrome and atherosclerosis in South Asians Living in America study. J Acad Nutr Diet 2014; 114:238-243. [PMID: 24295929 PMCID: PMC3947024 DOI: 10.1016/j.jand.2013.09.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/10/2013] [Indexed: 11/18/2022]
Abstract
Dietary patterns contribute to cardiovascular disease (CVD) risk. Asian Indians have earlier onset, more severe, and more prevalent CVD than many other racial/ethnic groups. We aimed to characterize dietary patterns in Asian Indians living in the United States and examine associations with cardiometabolic risk factors. One hundred fifty Asian Indians, aged 45 to 84 years, without known CVD, living in the San Francisco Bay, CA, area between August 2006 and October 2007 were enrolled into the Metabolic syndrome and Atherosclerosis in South Asians Living in America study. A food frequency questionnaire validated in Asian Indians, fasting blood samples, and computed tomography scans were obtained for all participants. Principal component analysis with varimax rotation was used to determine prevalent dietary patterns. Linear regression analyses were performed for associations between dietary patterns and metabolic factors, adjusting initially for age and sex, then additionally for BMI, income, education, metabolic equivalent of task-minutes of exercise, alcohol consumption, and smoking. Two distinct dietary patterns were identified that we termed "Western," and "Vegetarian." Compared with the Western diet, the Vegetarian diet was associated with lower homeostasis model of assessment-insulin resistance (-1.12 mmol/L × mU/L; P=0.05) and lower high-density lipoprotein cholesterol (-4.77 mg/dL; P=0.09). Given that the Western and Vegetarian dietary patterns were each associated with adverse metabolic changes, healthful diet choices may help Asian Indians improve risk factors for CVD.
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