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Pokhrel Bhattarai S, Dzikowicz DJ, Carey MG. Association Between Serum Albumin and the Length of Hospital Stay Among Patients With Acute Heart Failure. Biol Res Nurs 2024:10998004241262530. [PMID: 38869162 DOI: 10.1177/10998004241262530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Introduction: Albumin plays a vital role in improving osmotic pressure and hemodynamics. A lower serum albumin level may cause pulmonary congestion and edema and contribute to myocardial dysfunction, diuresis resistance, and fluid retention in acute heart failure. Hypothesis: We hypothesized that AHF patients with normal serum albumin have shorter hospital stays. Methods: Using Electronic Medical Records, patients admitted from May 2020 through May 2021 aged >18, ICD-10, and positive Framingham Heart Failure Diagnostic Criteria were included. We excluded patients without albumin records and eGFRs less than 30 mL/min/1.73 m2. Prolonged hospitalization was defined as >8 days of hospitalization. Results: During index emergency department visits, patients were symptomatic (New York Heart Association), aged median of 70 years (Interquartile range (IQR) 18), 59% (n = 103) were male, predominantly White (73%, n = 128), and had a high Charleston Comorbidity index score [5, IQR (4-7)]. Nearly one-fourth (23%, n = 41) of the patients had <3.5 g/dL albumin levels. The median length of hospital stay was eight days (IQR of 11). Comparing differences between lengths of hospital stays (<8 vs. >8 days), there was different serum albumin (3.9 + 0.48 vs. 3.6 + 0.53, p < .001) and left ventricular ejection fraction (45% (range 26-63) versus 30% (range 24-48), p = .004). An increased serum albumin decreased prolonged hospitalization (odds ratio (OR), 0.28; 95% confidence interval (CI), 0.14-0.55, p = <0.001). Patients in the lower albumin group had higher NT-proBNP (median: 8521 (range 2025-9134) versus 5147 (range 2966-14,795) pg/ml, p = .007) and delay in administering intravenous diuretics (391 (167-964) minutes versus 271 (range 157-533) minutes, p = .02). Conclusion: Hypoalbuminemia is strongly associated with prolonged hospitalization. Timely and effective diuretic therapy may reduce hospital stay durations, particularly with albumin supplementation.
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Affiliation(s)
| | - Dillon J Dzikowicz
- School of Nursing, University of Rochester, Rochester, NY, USA
- Medical Center, University of Rochester, Rochester, NY, USA
| | - Mary G Carey
- School of Nursing, University of Rochester, Rochester, NY, USA
- Medical Center, University of Rochester, Rochester, NY, USA
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Sadaf MI, Akbar UA, Nasir K, Hanif B, Virani SS, Patel KV, Khan SU. Cardiovascular Health and Disease in the Pakistani American Population. Curr Atheroscler Rep 2024; 26:205-215. [PMID: 38669004 DOI: 10.1007/s11883-024-01201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE OF REVIEW This narrative review seeks to elucidate clinical and social factors influencing cardiovascular health, explore the challenges and potential solutions for enhancing cardiovascular health, and identify areas where further research is needed to better understand cardiovascular issues in native and American Pakistani populations. RECENT FINDINGS The prevalence of cardiometabolic disease is high not only in Pakistan but also among its global diaspora. This situation is further complicated by the inadequacy of current cardiovascular risk assessment tools, which often fall short of accurately gauging the risk among Pakistani individuals, underscoring the urgent need for more tailored and effective assessment methodologies. Moreover, social determinants play a crucial role in shaping cardiovascular health. The burden of cardiovascular disease and upstream risk factors is high among American Pakistani individuals. Future research is needed to better understand the heightened risk of cardiovascular disease among Pakistani individuals.
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Affiliation(s)
- Murrium I Sadaf
- Department of Cardiology, University of Arkansas Medical Center, Little Rock, AR, USA
- John L. McClellan Memorial Veterans Hospital, Little Rock, AR, USA
| | - Usman Ali Akbar
- West Virginia University-Camden Clark Medical Center, Parkersburg, WV, USA
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Bashir Hanif
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Salim S Virani
- The Aga Khan University, Karachi, Pakistan
- Baylor College of Medicine, Texas Heart Institute, Houston, TX, USA
| | - Kershaw V Patel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Safi U Khan
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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Jain V, Rifai MA, Kanaya AM, Shah NS, Talegawkar SA, Virani SS, Michos ED, Blumenthal RS, Patel J. Association of cardiovascular health with subclinical coronary atherosclerosis progression among five racial and ethnic groups: The MASALA and MESA studies. Atherosclerosis 2024; 392:117522. [PMID: 38583288 DOI: 10.1016/j.atherosclerosis.2024.117522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/27/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS South Asian adults (SA) are at higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with other racial/ethnic groups. Life's Simple 7 (LS7) is a guideline-recommended, cardiovascular health (CVH) construct to guide optimization of cardiovascular risk factors. We sought to assess if the LS7 metrics predict coronary artery calcium (CAC) incidence and progression in asymptomatic SA compared with four other racial/ethnic groups. METHODS We assessed the distribution of CVH metrics (inadequate: score 0-8, average: 9-10, optimal: 11-14, and per 1-unit higher score) and its association with incidence and progression of CAC among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study compared with other race/ethnic groups from the Multiethnic Study of Atherosclerosis (MESA). RESULTS We included 810 SA, 2622 Non-Hispanic White (NHW), and 4192 Other adults (collectively 1893 Black, 1496 Hispanic and 803 Chinese American participants, respectively). SA and White participants compared to Other race/ethnicity groups were more likely to have optimal CVH metrics (26% SA vs 28% White participants vs 21% Other, respectively, p < 0.001). Similar to NHW and the Other race/ethnic group, SA participants with optimal baseline CVH were less likely to develop incident CAC on follow-up evaluation compared to participants with inadequate CVH metrics, optimal CVH/CAC = 0: 24% SA, 28% NHW, and 15% Other (p < 0.01). In multivariable linear and logistic regression models, there was no difference in annualized CAC incidence or progression between each race/ethnic group (pinteraction = 0.85 and pinteraction = 0.17, respectively). Optimal blood pressure control was associated with lower CAC incidence among SA participants [OR (95% CI): 0.30 (0.14-0.63), p < 0.01] and Other race and ethnicity participants [0.32 (0.19-0.53), p < 0.01]. CONCLUSIONS Optimal CVH metrics are associated with lower incident CAC and CAC progression among South Asians, similar to other racial groups/ethnicities. These findings underscore the importance of optimizing and maintaining CVH to mitigate the future risk of subclinical atherosclerosis in this higher risk population.
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Affiliation(s)
- Vardhmaan Jain
- Department of Cardiovascular Medicine, Emory University School of Medicine, GA, USA
| | - Mahmoud Al Rifai
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, TX, USA
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, USA
| | - Nilay S Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, IL, USA
| | - Sameera A Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, DC, USA
| | - Salim S Virani
- Department of Cardiovascular Medicine, Baylor College of Medicine, TX, USA & the Aga Khan University, Karachi, Pakistan
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, MD, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, MD, USA
| | - Jaideep Patel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, MD, USA.
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Zhu AL, Le AD, Li Y, Palaniappan LP, Srinivasan M, Shah NS, Wong SS, Valero-Elizondo J, Elfassy T, Yang E. Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups. J Am Heart Assoc 2024; 13:e032509. [PMID: 38567660 DOI: 10.1161/jaha.123.032509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups. METHODS AND RESULTS We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% self-identified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04-2.03) and Filipino (OR, 1.24; 95% CI, 1.02-1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03-1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22-1.65), Chinese (OR, 1.58; 95% CI, 1.33-1.88), and Filipino (OR, 1.24; 95% CI, 1.06-1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01-1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15-2.11) and Filipino (OR, 1.50; 95% CI, 1.14-1.97) adults. CONCLUSIONS Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.
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Affiliation(s)
- Alicia L Zhu
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- College of Arts and Sciences, School of Global Public Health New York University New York NY
| | - Austin D Le
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Environmental Health Sciences Division University of California, Berkeley, School of Public Health Berkeley CA
| | - Yuemeng Li
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta GA
| | - Latha P Palaniappan
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Malathi Srinivasan
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Nilay S Shah
- Departments of Medicine (Cardiology) and Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sally S Wong
- American Heart Association, Office of Science, Medicine, and Health Dallas TX
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Tali Elfassy
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Department of Medicine, Division of Nephrology and Hypertension University of Miami Miller School of Medicine Miami FL
| | - Eugene Yang
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Cardiology University of Washington School of Medicine Seattle WA
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Shin C, Belyea M. The Moderating Role of Collectivism on Physical Activity and Family Support: A Cross-Sectional Design. FAMILY & COMMUNITY HEALTH 2024; 47:108-116. [PMID: 38372328 DOI: 10.1097/fch.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND An important value among Korean Americans is collectivism or giving a group priority over the individual. This value, family support, and demographic characteristics have been reported to influence health behaviors among this group. Yet, no study has examined how collectivism, family support, and demographic characteristics interact with each other and then influence physical activity among Korean American adults. The purpose of the study was to examine the association between family support and physical activity, and the moderating role of demographic characteristics and collectivism on this association among Korean American adults. METHODS A descriptive, cross-sectional study was conducted with a sample of 110 Korean American adults 18 years and older, residing in a Southwestern city in the United States. Self-administered questionnaires were used to measure demographics, collectivism, family support, and physical activity. RESULTS Data analysis using a zero-inflated negative binomial regression model revealed a positive relationship between family support and physical activity, while age and gender were moderators of the relationship between family support and physical activity. Collectivism was positively related to physical activity and moderated the relationship between family support and physical activity. CONCLUSION These findings indicate the significance of collectivism and family support that influence Korean American adults' physical activity.
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Affiliation(s)
- Chanam Shin
- College of Nursing, Texas Woman's University, Denton (Dr Shin); and Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Dr Belyea)
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Vo V, Lopez G, Malay S, Roman YM. Cardiovascular Risk Factors Among Asian Americans: Perspectives on the Role of Acculturation in Cardiovascular Diseases Health Disparities. J Immigr Minor Health 2024; 26:409-420. [PMID: 37222869 DOI: 10.1007/s10903-023-01489-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/25/2023]
Abstract
The growing prevalence of cardiovascular diseases in the United States (US) has disproportionately affected minority populations more than their white counterparts. A population that is often overlooked is the Asian American population, particularly Southeastern Asian immigrants. Despite having relatively favorable socioeconomic indicators compared to the general US population, Asian Americans, specifically Southeast Asian individuals, face a significant burden of traditional cardiovascular risk factors and are considered a high cardiovascular disease risk group. In addition, most studies have aggregated Asian populations into one major racial group rather than analyzing the different ethnicities among the Asian categorization. While some studies suggest that the acculturation process has some degree of impact on cardiovascular health, there has not been a widely-used tool to measure or ascertain the totality of acculturation. Instead, multiple proxies have been used to measure acculturation, and prior studies have argued for more culturally-tailored acculturation proxies. This paper aims to assess the implications of different acculturation measures on cardiovascular health among Asian Americans, particularly Southeastern Asian immigrants. The following proxies were expanded on in this paper: English spoken at home, length of stay in the US, religiosity and spirituality, and admixed family structures. Previous studies showed that as the length of stay in the US increases, the burden of cardiovascular risk factors increases. However, the impact of English spoken at home, religiosity, and admixed family structure are still inconclusive given the extent of current studies. While most studies suggest that an increase in acculturation increases the risk of cardiovascular disease, it is critical to note that acculturation is a multifaceted process. Therefore, more studies are necessary to appropriately examine the implications of various acculturation processes on cardiovascular risk factors in Asians, specifically Southeastern Asian individuals in the US.
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Affiliation(s)
- Victoria Vo
- Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, 23298, USA
| | - Glydel Lopez
- Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
| | - Shravani Malay
- Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, 23298, USA
| | - Youssef M Roman
- Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, 23298, USA.
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7
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Perera S, Zheng Z, Wadhera RK. Cardiovascular Health, Lifestyle Factors, and Social Determinants in Asian Subpopulations in the United States. Am J Cardiol 2024; 216:77-86. [PMID: 38369173 DOI: 10.1016/j.amjcard.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
Asian Americans are often aggregated in national public health surveillance efforts, which may conceal important differences in the health status of subgroups that are included in this highly diverse population. Little is known about how cardiovascular health varies across Asian subpopulations and the extent to which lifestyle and social risk factors contribute to any observed differences. This national study used data from the National Health Interview Survey to evaluate the burden of cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus) and cardiovascular diseases (heart attack, coronary heart disease, angina, stroke) across Asian groups (Chinese, Asian Indian, Filipino, Other Asian), and determine whether differences are related to lifestyle factors and/or social determinants of health. The weighted study population included 13,592,178 Asian adults. Filipino adults were more likely to have hypertension than Chinese adults (29.4% vs 15.4%; adjusted odds ratio [OR] 2.40, 95% confidence interval [1.91 to 3.02]), as were Asian Indians (15.7%; OR 1.59 [1.25 to 2.02]). These patterns were similar for hyperlipidemia and diabetes mellitus. For cardiovascular diseases, Filipino adults were significantly more likely to have coronary heart disease (4.2% vs 1.9%; OR 2.19 [1.32 to 3.56]), heart attack (2.6% vs 0.9%; OR 2.79 [1.44 to 5.41]), angina (1.8% vs 0.9%; OR 2.15 [1.06 to 4.32]), and stroke (2.1% vs 0.8%; OR 2.54 [1.42 to 4.55]) compared with Chinese adults, whereas there were no differences compared with Asian Indian adults. Adjustments for lifestyle factors and social determinants completely attenuated differences in coronary heart disease, heart attack, and angina among subpopulations. In conclusion, these findings demonstrate that cardiovascular risk factors and diseases vary significantly across Asian subpopulations, with Filipino adults experiencing the highest burden and Chinese adults the lowest, and that differences in cardiovascular disease are largely attenuated after adjustment for lifestyle and social determinants.
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Affiliation(s)
- Sudheesha Perera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - ZhaoNian Zheng
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Lim A, Elias S, Benjasirisan C, Byiringiro S, Chen Y, Turkson‐Ocran R, Dennison Himmelfarb CR, Commodore‐Mensah Y, Koirala B. Heterogeneity in the Prevalence of Cardiovascular Risk Factors by Ethnicity and Birthplace Among Asian Subgroups: Evidence From the 2010 to 2018 National Health Interview Survey. J Am Heart Assoc 2024; 13:e031886. [PMID: 38420759 PMCID: PMC10944060 DOI: 10.1161/jaha.123.031886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Asian people in the United States have different sociodemographic and health-related characteristics that might affect cardiovascular disease (CVD) risk by ethnicity and birthplace. However, they are often studied as a monolithic group in health care research. This study aimed to examine heterogeneity in CVD risk factors on the basis of birthplace among the 3 largest Asian subgroups (Chinese, Asian Indian, and Filipino) compared with US-born non-Hispanic White (NHW) adults. METHODS AND RESULTS A cross-sectional analysis was conducted using the 2010 to 2018 National Health Interview Survey data from 125 008 US-born and foreign-born Chinese, Asian Indian, Filipino, and US-born NHW adults. Generalized linear models with Poisson distribution were used to examine the prevalence and prevalence ratios of self-reported hypertension, diabetes, high cholesterol, physical inactivity, smoking, and overweight/obesity among Asian subgroups compared with US-born NHW adults. The study included 118 979 US-born NHW and 6029 Asian adults who self-identified as Chinese (29%), Asian Indian (33%), and Filipino (38%). Participants' mean (±SD) age was 49±0.1 years, and 53% were females. In an adjusted analysis, foreign-born Asian Indians had significantly higher prevalence of diabetes, physical inactivity, and overweight/obesity; foreign-born Chinese had higher prevalence of physical inactivity, and foreign-born Filipinos had higher prevalence of all 5 CVD risk factors except smoking compared with NHW adults. CONCLUSIONS This study revealed significant heterogeneity in the prevalence of CVD risk factors among Asian subgroups by ethnicity and birthplace, stressing the necessity of disaggregating Asian subgroup data. Providers should consider this heterogeneity in CVD risk factors and establish tailored CVD prevention plans for Asian subgroups.
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Affiliation(s)
- Arum Lim
- Johns Hopkins School of NursingBaltimoreMDUSA
| | | | | | | | - Yuling Chen
- Johns Hopkins School of NursingBaltimoreMDUSA
| | - Ruth‐Alma Turkson‐Ocran
- Beth Israel Deaconess Medical Center, Division of General MedicineHarvard Medical SchoolBostonMAUSA
| | - Cheryl R. Dennison Himmelfarb
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Johns Hopkins School of MedicineBaltimoreMDUSA
| | - Yvonne Commodore‐Mensah
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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Bacong AM, Gibbs SL, Rosales AG, Frankland TB, Li J, Daida YG, Fortmann SP, Palaniappan L. Obesity Disparities Among Adult Single-Race and Multiracial Asian and Pacific Islander Populations. JAMA Netw Open 2024; 7:e240734. [PMID: 38502128 PMCID: PMC10951735 DOI: 10.1001/jamanetworkopen.2024.0734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/09/2024] [Indexed: 03/20/2024] Open
Abstract
Importance Despite increasing numbers of multiracial individuals, they are often excluded in studies or aggregated within larger race and ethnicity groups due to small sample sizes. Objective To examine disparities in the prevalence of obesity among single-race and multiracial Asian and Pacific Islander individuals compared with non-Hispanic White (hereafter, White) individuals. Design, Setting, and Participants This cross-sectional study used electronic health record (EHR) data linked to social determinants of health and health behavior data for adult (age ≥18 years) members of 2 large health care systems in California and Hawai'i who had at least 1 ambulatory visit to a primary care practitioner between January 1, 2006, and December 31, 2018. Data were analyzed from October 31, 2022, to July 31, 2023. Exposure Self-identified race and ethnicity provided in the EHR as a single-race category (Asian Indian, Chinese, Filipino, Japanese, Native Hawaiian only, Other Pacific Islander, or White) or a multiracial category (Asian and Pacific Islander; Asian, Pacific Islander, and White; Asian and White; or Pacific Islander and White). Main Outcomes and Measures The main outcome was obesity (body mass index [BMI] ≥30.0), based on last measured height and weight from the EHR. Logistic regression was used to examine the association between race and ethnicity and odds of obesity. Results A total of 5229 individuals (3055 [58.4%] male; mean [SD] age, 70.73 [11.51] years) were examined, of whom 444 (8.5%) were Asian Indian; 1091 (20.9%), Chinese; 483 (9.2%), Filipino; 666 (12.7%), Japanese; 91 (1.7%), Native Hawaiian; 95 (1.8%), Other Pacific Islander; and 888 (17.0%), White. The percentages of individuals who identified as multiracial were as follows: 417 (8.0%) were Asian and Pacific Islander; 392 (7.5%), Asian, Pacific Islander, and White; 248 (4.7%), Asian and White; and 414 (7.9%), Pacific Islander and White. A total of 1333 participants (25.5%) were classified as having obesity based on standard BMI criteria. Obesity was highest among people who identified as Asian, Pacific Islander, and White (204 of 392 [52.0%]) followed by those who identified as Other Pacific Islander (47 of 95 [49.5%]), Native Hawaiian (44 of 91 [48.4%]), and Pacific Islander and White (186 of 414 [44.9%]). After accounting for demographic, socioeconomic, and health behavior factors, people who identified as Asian, Pacific Islander, and White (odds ratio [OR], 1.80; 95% CI, 1.37-2.38) or Pacific Islander and White (OR, 1.55; 95% CI, 1.18-2.04) had increased odds of obesity compared with White individuals. All single-race Asian groups had lower odds of obesity compared with White individuals: Asian Indian (OR, 0.29; 95% CI, 0.20-0.40), Chinese (OR, 0.22; 95% CI, 0.17-0.29), Filipino (OR, 0.46; 95% CI, 0.35-0.62), and Japanese (OR, 0.38, 95% CI, 0.29-0.50). Conclusions and Relevance In this study, multiracial Asian and Pacific Islander individuals had an increased prevalence of obesity compared with many of their single-race counterparts. As the number of multiracial individuals increases, it will be important for clinical and public health systems to track disparities in these populations.
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Affiliation(s)
- Adrian M. Bacong
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Center for Asian Health Research and Education, Stanford, California
| | | | | | | | - Jiang Li
- Sutter Health Center for Health Systems Research/Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai’i, Honolulu
| | | | - Latha Palaniappan
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Center for Asian Health Research and Education, Stanford, California
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Zuin M, Overvad TF, Albertsen IE, Bilato C, Piazza G. Trends of Pulmonary Embolism-Related Sudden Cardiac Death in the United States, 1999-2019. J Thromb Thrombolysis 2024; 57:483-491. [PMID: 38281229 DOI: 10.1007/s11239-024-02946-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Up-to-date population-based data on pulmonary embolism (PE)-related sudden cardiac death (SCD) mortality trends in the United States (US) are scant. We assess the current trends in PE-related SCD mortality in US over the past two decades and determine differences by sex, race, ethnicity, age, and census region. METHODS We extracted PE-related SCD mortality rates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2019, in patients aged ≥ 15 years old. Age-adjusted mortality rates (AAMRs) were assessed using the Joinpoint regression modeling and expressed as estimated average annual percentage change (AAPC) with relative 95% confidence intervals (CIs). RESULTS Between 1999 and 2019, the AAMR from acute PE-related SCD mortality in the US linearly increased [AAPC: +2.4% (95% CI: 2.2 to 2.6), p < 0.001)]. The AAMR increase was more pronounced in men [AAPC: +2.8% (95% CI: 2.6 to 2.9), p < 0.001], Whites [AAPC: +2.7% (95% CI: 2.3 to 3.1), p < 0.001], Latinx/Hispanic patients [AAPC:+2.0% (95% CI: 1.2 to 2.8), p < 0.001], subjects younger than 65 years [AAPC: +2.4% (95% CI: 2.1 to 2.6), p < 0.001] and in residents of rural areas [AAPC: +3.6% (95% CI: 3.3 to 3.9), p < 0.001]. Moreover, higher percentages of PE-related SCD and the relative absolute number of deaths were observed in the South compared with other geographical regions. CONCLUSIONS PE-related SCD mortality in the US has increased over the last two decades. Stratification by race, ethnicity, urbanization, and census region demonstrates ethnoracial and regional disparities that require further investigation and remedy.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy.
| | | | - Ida Ehlers Albertsen
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Gregory Piazza
- Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Sarraju A, Yan X, Huang Q, Dudum R, Palaniappan L, Rodriguez F. Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity. Am J Prev Cardiol 2024; 17:100647. [PMID: 38525197 PMCID: PMC10958062 DOI: 10.1016/j.ajpc.2024.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/27/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Objective There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We aimed to evaluate statin use and LDL-c control for ASCVD by race and ethnicity. Methods From an electronic health record (EHR)-based cohort from a multisite Northern California health system, we included adults with an ASCVD diagnosis from 2010 to 2021 and at least 2 primary care visits, stratified by race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [Black], Hispanic, and Asian). Hispanic (Mexican, Puerto Rican, Other) and Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other) groups were disaggregated. Primary outcomes were 1-year post-ASCVD statin use (prescription) and LDL-c control (at least one value <70 mg/dL). Adjusted odds ratios (ORs) were estimated using logistic regression. Results Of 133,158 patients, there were 89,944 NHW, 6,294 Black, 12,478 (9.4 %) Hispanic and 13,179 (9.9 %) Asian patients. At 1 year after incident ASCVD, there was suboptimal statin use (any statins <60 %, high-intensity <25 %) and LDL-c control (<30 %) across groups, with lowest proportions in Black patients for statin use (46.7 %, any statin) and LDL-c control (10.7 %, OR 0.89 (0.81-0.97), referent NHW). Disaggregation of Asian and Hispanic groups unmasked within-group heterogeneity. Conclusions In patients with incident ASCVD, we describe suboptimal and heterogenous 1-year post-ASCVD guideline-directed statin use and 1-year post-ASCVD LDL-c control across disaggregated race and ethnicity groups. Findings may improve understanding of ASCVD treatment disparities and guide implementation.
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Affiliation(s)
- Ashish Sarraju
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaowei Yan
- Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USA
| | - Qiwen Huang
- Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USA
| | - Ramzi Dudum
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Latha Palaniappan
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
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12
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Pham HN, Ibrahim R, Sainbayar E, Aiti D, Mouhaffel R, Shahid M, Ozturk NB, Olson A, Ferreira JP, Lee K. Ischemic heart disease mortality in individuals with inflammatory bowel disease: A nationwide analysis of disparities in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00072-1. [PMID: 38431496 DOI: 10.1016/j.carrev.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is linked to immune-mediated pathogenesis and a pro-inflammatory state, leading to accelerated atherosclerosis. This earlier onset of clinical cardiovascular disease poses significant morbidity and mortality. We sought to identify IHD mortality trends in individuals with IBD in the United States (US). METHODS Mortality due to ischemic heart diseases (IHD) as the underlying cause of death with the IBD as a contributor of death were queried from death certificates using the CDC database from 1999 to 2020. Yearly crude mortality rates (CMR) were estimated by dividing the death count by the respective population size, reported per 100,000 persons. Mortality rates were adjusted for age using the Direct method and compared by demographic subpopulations. Log-linear regression models were utilized to assess temporal variation (annual percentage change [APC]) in mortality. RESULTS Age-adjusted mortality rates (AAMR) decreased from 0.11 in 1999 to 0.07 in 2020, primarily between 1999 and 2018 (APC -4.41, p < 0.001). AAMR was higher among male (AAMR 0.08) and White (AAMR 0.08) populations compared to female populations (AAMR 0.06) and Black (AAMR 0.04) populations, respectively. No significant differences were seen when comparing mortality between urban (AAMR 0.07) and rural (AAMR 0.08) regions. Southern US regions (AAMR 0.06) had the lowest mortality rates when compared to the other US census regions: Northeastern (AAMR 0.08), Midwestern (AAMR 0.08), and Western (AAMR 0.08). CONCLUSION Disparities in IHD mortality exist among individuals with IBD in the US based on demographic factors, with an overall decline in mortality during the 22-year period. Further investigation is warranted to confirm these findings and evaluate for contributors to the observed disparities.
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Affiliation(s)
- Hoang Nhat Pham
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Ramzi Ibrahim
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America. https://twitter.com/ramziw_
| | - Enkhtsogt Sainbayar
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Danny Aiti
- Department of Medicine, Canton Medical Education Foundation-Northeast Ohio Medical University, Canton, OH, United States of America
| | - Rama Mouhaffel
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Mahek Shahid
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Nazli Begum Ozturk
- Department of Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - April Olson
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - João Paulo Ferreira
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Kwan Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, United States of America
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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14
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Minhas AMK, Kobo O, Mamas MA, Al-Kindi SG, Abushamat LA, Nambi V, Michos ED, Ballantyne C, Abramov D. Social Vulnerability and Cardiovascular-Related Mortality Among Older Adults in the United States. Am J Med 2024; 137:122-127.e1. [PMID: 37879590 DOI: 10.1016/j.amjmed.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE The association of social vulnerability and cardiovascular disease-related mortality in older adults has not been well characterized. METHODS The Centers for Disease Control and Prevention database was evaluated to examine the relationship between county-level Social Vulnerability Index (SVI) and age-adjusted cardiovascular disease-related mortality rates (AAMRs) in adults aged 65 and above in the United States between 2016 and 2020. RESULTS A total of 3139 counties in the United States were analyzed. Cardiovascular disease-related AAMRs increased in a stepwise manner from first (least vulnerable) to fourth SVI quartiles; (AAMR of 2423, 95% CI [confidence interval] 2417-2428; 2433, 95% CI 2429-2437; 2516, 95% CI 2513-2520; 2660, 95% CI 2657-2664). Similar trends among AAMRs were noted based on sex, all race and ethnicity categories, and among urban and rural regions. Higher AAMR ratios between the highest and lowest SVI quartiles, implying greater relative associations of SVI on mortality rates, were seen among Hispanic individuals (1.52, 95% CI 1.49-1.55), Non-Hispanic-Asian and Pacific Islander individuals (1.32, 95% CI 1.29-1.52), Non-Hispanic- American Indian or Alaskan Native individuals (1.43, 95% CI 1.37-1.50), and rural counties (1.21, 95% CI 1.20-1.21). CONCLUSION Social vulnerability as measures by the SVI was associated with cardiovascular disease-related mortality in older adults, with the association being particularly prominent in ethnic minority patients and rural counties.
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Affiliation(s)
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, Ohio
| | - Layla A Abushamat
- Department of Medicine, Baylor College of Medicine, Houston, Tex; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Tex
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, Tex; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Tex
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Christie Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, Tex; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Tex
| | - Dmitry Abramov
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Calif.
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Muniyappa R, Narayanappa SBK. Disentangling Dual Threats: Premature Coronary Artery Disease and Early-Onset Type 2 Diabetes Mellitus in South Asians. J Endocr Soc 2023; 8:bvad167. [PMID: 38178904 PMCID: PMC10765382 DOI: 10.1210/jendso/bvad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 01/06/2024] Open
Abstract
South Asian individuals (SAs) face heightened risks of premature coronary artery disease (CAD) and early-onset type 2 diabetes mellitus (T2DM), with grave health, societal, and economic implications due to the region's dense population. Both conditions, influenced by cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity, manifest earlier and with unique thresholds in SAs. Epidemiological, demographic, nutritional, environmental, sociocultural, and economic transitions in SA have exacerbated the twin epidemic. The coupling of premature CAD and T2DM arises from increased obesity due to limited adipose storage, early-life undernutrition, distinct fat thresholds, reduced muscle mass, and a predisposition for hepatic fat accumulation from certain dietary choices cumulatively precipitating a decline in insulin sensitivity. As T2DM ensues, the β-cell adaptive responses are suboptimal, precipitating a transition from compensatory hyperinsulinemia to β-cell decompensation, underscoring a reduced functional β-cell reserve in SAs. This review delves into the interplay of these mechanisms and highlights a prediabetes endotype tied to elevated vascular risk. Deciphering these mechanistic interconnections promises to refine stratification paradigms, surpassing extant risk-prediction strategies.
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Affiliation(s)
- Ranganath Muniyappa
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Satish Babu K Narayanappa
- Department of Medicine, Sri Madhusudan Sai Institute of Medical Sciences and Research, Muddenahalli, Karnataka 562101, India
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Zaveri S, Qu YS, Chahine M, Boutjdir M. Ethnic and racial differences in Asian populations with ion channelopathies associated with sudden cardiac death. Front Cardiovasc Med 2023; 10:1253479. [PMID: 37600027 PMCID: PMC10436680 DOI: 10.3389/fcvm.2023.1253479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Cardiovascular diseases are associated with several morbidities and are the most common cause of worldwide disease-related fatalities. Studies show that treatment and outcome-related differences for cardiovascular diseases disproportionately affect minorities in the United States. The emergence of ethnic and racial differences in sudden cardiac death (SCD) and related ion channelopathies complicates cardiovascular disease prevention, diagnosis, management, prognosis, and treatment objectives for patients and physicians alike. This review compiles and synthesizes current research in cardiac ion channelopathies and genetic disorders in Asian populations, an underrepresented population in cardiovascular literature. We first present a brief introduction to SCD, noting relevant observations and statistics from around the world, including Asian populations. We then examined existing differences between Asian and White populations in research, treatment, and outcomes related to cardiac ion channelopathies and SCD, showing progression in thought and research over time for each ion channelopathy. The review also identifies research that explored phenotypic abnormalities, device usage, and risk of death in Asian patients. We touch upon the unique genetic risk factors in Asian populations that lead to cardiac ion channelopathies and SCD while comparing them to White and Western populations, particularly in the United States, where Asians comprise approximately 7% of the total population. We also propose potential solutions such as improving early genetic screening, addressing barriers affecting access to medical care and device utilization, physician training, and patient education on risks.
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Affiliation(s)
- Sahil Zaveri
- Department of Medicine, Cell Biology, and Pharmacology, State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
- Cardiovascular Research Program, VA New York Harbor Healthcare System, New York, NY, United States
| | - Yongxia Sarah Qu
- Department of Medicine, Cell Biology, and Pharmacology, State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
- Cardiovascular Research Program, VA New York Harbor Healthcare System, New York, NY, United States
- Department of Cardiology, New York Presbyterian Brooklyn Methodist Hospital, New York, NY, United States
| | - Mohamed Chahine
- CERVO Brain Research Center, Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
- Department of Medicine, Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Mohamed Boutjdir
- Department of Medicine, Cell Biology, and Pharmacology, State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
- Cardiovascular Research Program, VA New York Harbor Healthcare System, New York, NY, United States
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
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17
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Claudel SE, Waikar SS, Schmidt IM, Verma A. Kidney Disease-Related Mortality Among Asian Americans. Kidney Med 2023; 5:100676. [PMID: 37576431 PMCID: PMC10421978 DOI: 10.1016/j.xkme.2023.100676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Affiliation(s)
- Sophie E. Claudel
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Sushrut S. Waikar
- Renal Section, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Insa M. Schmidt
- Renal Section, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Ashish Verma
- Renal Section, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
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18
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Shah NS, Talegawkar SA, Jin Y, Hussain BM, Kandula NR, Kanaya AM. Cardiovascular Health by Life's Essential 8 and Associations With Coronary Artery Calcium in South Asian American Adults in the MASALA Study. Am J Cardiol 2023; 199:71-77. [PMID: 37262988 PMCID: PMC10330648 DOI: 10.1016/j.amjcard.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/19/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
South Asian Americans experience high cardiovascular disease risk. We evaluated the distribution and correlates of cardiovascular health (CVH) summarized by the Life's Essential 8 (LE8) score among South Asian adults. In participants of the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study, the association of demographic, social, and cultural factors with LE8 score was evaluated with t tests and analysis of variance. The association of LE8 score with coronary artery calcium (CAC) was evaluated with adjusted logistic regression. There were 556 women (mean age 55.9 years [SD 8.7], mean LE8 score 67.2 (SD 12.6) and 608 men (mean age 57.5 years [SD 9.9], mean LE8 score 61.9 (SD 13.1). Among women and men, the LE8 CVH score was higher in participants with higher annual family income, higher educational attainment, and fewer depressive symptoms. Overall, there was 26% lower odds of any CAC for each 10-point higher LE8 score (odds ratios [OR] 0.74, 95% confidence intervals [CI] 0.66 to 0.83), with similar magnitude of association in women and men. Participants with a high LE8 CVH score had 82% lower odds of CAC (OR 0.18, 95% CI 0.09 to 0.33), and participants with an intermediate LE8 CVH score had 38% lower odds of CAC (OR 0.62, 95% CI 0.41 to 0.94) than did participants with a low LE8 CVH score, with similar findings stratified by gender. In conclusion, in this cohort of South Asian Americans, most adults had suboptimal CVH assessed by the LE8 score. Higher LE8 score correlated with lower odds of any CAC.
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Affiliation(s)
- Nilay S Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Sameera A Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Yichen Jin
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Bridget Murphy Hussain
- Department of Epidemiology, School of Global Public Health, New York University, New York, New York
| | - Namratha R Kandula
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alka M Kanaya
- Department of Medicine, University of California-San Francisco, San Francisco, California
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Shah NS, Shimbo D, Muntner P, Huffman MD, Kandula NR, Mefford MT, Lloyd-Jones DM, Khan SS. Hypertension-Related Cardiovascular Mortality in Asian American Subgroups. Am J Prev Med 2023; 65:117-121. [PMID: 36759227 PMCID: PMC10293105 DOI: 10.1016/j.amepre.2023.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Asian American subgroups experience heterogeneity in cardiovascular disease, but differences in hypertension-related cardiovascular disease mortality between Asian American subgroups is not known. METHODS Among 1,194,648 deaths in the United States in 2018-2021 with cardiovascular disease as an underlying cause and hypertension-related diseases as contributing cause, sex-specific age-standardized mortality rates, proportional mortality, and proportional mortality ratios for non-Hispanic Asian and Asian subgroups, Hispanic, and non-Hispanic Black individuals were compared with non-Hispanic White individuals. The analysis was conducted in August 2022. RESULTS There were 37,746; 95,404; 193,899; and 867,599 hypertension-related cardiovascular disease deaths in non-Hispanic Asian; Hispanic; non-Hispanic Black; and non-Hispanic White groups, respectively. Among non-Hispanic Asian females, mortality rates ranged from 41.6 (95% CI 40.0-43.3) per 100,000 population in Japanese to 52.6 (51.0-54.2) per 100,000 in Filipina individuals. Among non-Hispanic Asian males, mortality rates ranged from 45.8 (43.3-48.2) per 100,000 in Korean to 81.0 (78.5-83.5) per 100,000 in Filipino individuals. Proportional mortality was higher for all Asian American subgroups compared to non-Hispanic White individuals. Proportional mortality ratios ranged from 1.11 (in Korean males, proportional mortality was 10.2% [95% CI 9.7-10.8] of all deaths) to 1.38 (in Filipino males, proportional mortality was 12.7% [12.4-13.1] of all deaths; in Chinese females, proportional mortality was 11.9% [11.6-12.3]; and in Filipina females, proportional mortality was 11.9% [12.3-13.0]). CONCLUSIONS There was up to two-fold variation in hypertension-related cardiovascular disease mortality among Asian American subgroups. All subgroups experienced higher proportional mortality for hypertension-related cardiovascular disease compared with non-Hispanic White individuals.
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Affiliation(s)
- Nilay S Shah
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark D Huffman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Global Health Center, Institute for Public Health, Washington University School of Medicine in St. Louis, St. Louis, Missouri; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Namratha R Kandula
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew T Mefford
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Donald M Lloyd-Jones
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Gulati RK, Husaini M, Dash R, Patel J, Shah NS. Clinical programs for cardiometabolic health for South Asian patients in the United States: A review of key program components. HEALTH SCIENCES REVIEW (OXFORD, ENGLAND) 2023; 7:100093. [PMID: 37275679 PMCID: PMC10237508 DOI: 10.1016/j.hsr.2023.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Medical literature shows that South Asians have approximately a 2-fold higher risk of atherosclerotic cardiovascular disease (CVD) compared with other populations. Given this high prevalence, clinical programs to promote cardiovascular health have emerged in the United States that are dedicated to clinical care for South Asian individuals. In this review, we have summarized the key characteristics of clinical programs in the U.S. dedicated to preventing and managing CVD in South Asian American patients. These clinical centers have many unique components in common that are catered to South Asian patient populations including ethnicity concordance of clinical providers, intensive cardiovascular screening protocols with laboratory studies and potentially genetic testing, dieticians and nutritionists who are familiar with South Asian-style dietary patterns, health coaches to support behavior change, community outreach programs, and involvement in clinical research to learn further about risk factors, prevention, and treatment of cardiovascular disease in South Asian populations. There are still many evidence and programmatic gaps left to uncover in the prevention, diagnosis, and management of CVD in South Asian. This review provides guidance for important features, barriers, and facilitators for future cardiovascular centers to develop in the United States where they can serve South Asian populations.
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Affiliation(s)
- Reeti K. Gulati
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mustafa Husaini
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Rajesh Dash
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jaideep Patel
- South Asian Cardiovascular Health Initiative (SACHI) for the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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21
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Johnston EA, Park A, Hu L, Yi SS, Thorpe LE, Rummo PE, Beasley JM. Relative validity of a Diet Risk Score (DRS) for Chinese American adults. BMJ Nutr Prev Health 2023; 6:76-82. [PMID: 37484538 PMCID: PMC10359583 DOI: 10.1136/bmjnph-2022-000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/03/2023] [Indexed: 07/25/2023] Open
Abstract
Objective The objective of this study was to evaluate the relative validity of the nine-item Diet Risk Score (DRS) among Chinese American adults using Healthy Eating Index (HEI)-2015 scores. We provide insights into the application of the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) for this population, and report on lessons learned from carrying out participant recruitment during the COVID-19 pandemic. Methods Thirty-three Chinese American adults (mean age=40; 36% male) were recruited from the community and through ResearchMatch. Participants completed the DRS and two 24-hour food records, which were entered into the ASA 24-Hour Dietary Assessment Tool (ASA24) by community health workers (CHWs). HEI-2015 scores were calculated from each food record and an average score was obtained for each participant. One-way analysis of variance and Spearman correlations were used to compare total and component scores between the DRS and HEI-2015. Results Mean HEI-2015 score was 56.7/100 (SD 10.6) and mean DRS score was 11.8/27 (SD 4.7), with higher scores reflecting better and worse diets, respectively. HEI-2015 and DRS scores were inversely correlated (r=-0.43, p<0.05). The strongest correlations were between HEI-2015 Total Vegetables and DRS Vegetables (r=-0.5, p<0.01), HEI-2015 Total Vegetables and Green Vegetables (r=-0.43, p=0.01) and HEI-2015 Seafood/Plant Protein and DRS Fish (r=-0.47, p<0.01). The inability to advertise and recruit for the study in person at community centres due to pandemic restrictions impeded the recruitment of less-acculturated individuals. A lack of cultural food items in the ASA24 database made it difficult to record dietary intake as reported by participants. Conclusion The DRS can be a valuable tool for physicians to identify and reach Chinese Americans at risk of cardiometabolic disease.
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Affiliation(s)
- Emily A Johnston
- Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Agnes Park
- Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Lu Hu
- Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Stella S Yi
- Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lorna E Thorpe
- Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Pasquale E Rummo
- Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jeannette M Beasley
- Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Nutrition and Food Studies, New York University Steinhardt School of Culture Education and Human Development, New York, New York, USA
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22
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Shah NS, Khan SS, Carnethon MR, Bacong AM, Palaniappan LP. Diabetes-Related Cardiovascular and All-Cause Mortality in Asian American Subgroups. JACC. ASIA 2023; 3:365-372. [PMID: 37323867 PMCID: PMC10261884 DOI: 10.1016/j.jacasi.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/02/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Background Asian Americans experience heterogeneity in cardiovascular risk factors and cardiovascular disease, with a particularly high burden of diabetes in several Asian subgroups. Objectives The objectives of this study were to quantify diabetes-related mortality in Asian American subgroups and compare this with Hispanic, non-Hispanic Black, and non-Hispanic White individuals. Methods Using national-level vital statistics data and concurrent population estimates, age-standardized mortality rates and proportional mortality from diabetes-related mortality were calculated for non-Hispanic Asian (and subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Hispanic, non-Hispanic Black, and non-Hispanic White populations in the United States, 2018-2021. Results Diabetes-related deaths numbered 45,249 in non-Hispanic Asian, 159,279 in Hispanic, 209,281 in non-Hispanic Black, and 904,067 in non-Hispanic White individuals. Among Asian Americans, age-standardized mortality rates of diabetes-related mortality with cardiovascular disease as underlying cause ranged from 10.8 (95% CI: 9.9-11.6) per 100,000 in Japanese females to 19.9 (95% CI: 18.9-20.9) per 100,000 in Filipina females, and from 15.3 (95% CI: 13.9-16.8) per 100,000 in Korean males to 37.8 (95% CI: 36.1-39.5) per 100,000 in Filipino males. The proportion of all deaths related to diabetes was higher in all Asian subgroups (9.7%-16.4% for females; 11.8%-19.2% for males) compared with non-Hispanic Whites (8.5% for females; 10.7% for males). The highest proportion of diabetes-related deaths occurred in Filipino adults. Conclusions There was an approximately 2-fold variation in diabetes-related mortality among Asian American subgroups, with Filipino adults experiencing the greatest burden. All Asian subgroups experienced higher proportional mortality for diabetes-related mortality compared with non-Hispanic White individuals.
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Affiliation(s)
- Nilay S. Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California, USA
| | - Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adrian M. Bacong
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Latha P. Palaniappan
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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23
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Shetty NS, Patel N, Gaonkar M, Kalra R, Li P, Pavela G, Arora G, Arora P. Trends of cardiovascular health in Asian American individuals: A national health and nutrition examination survey study. Am J Prev Cardiol 2023; 14:100509. [PMID: 37334161 PMCID: PMC10273280 DOI: 10.1016/j.ajpc.2023.100509] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023] Open
Abstract
Objective Oversampling of Asian American individuals in the National Health and Nutrition Examination Survey (NHANES) provides a unique opportunity to assess the population-level cardiovascular health (CVH) in the fastest-growing racial group in the US. Methods The Life's Essential 8 (LE8) score and its components were calculated in self-reported Asian American individuals ≥20 years of age and free of cardiovascular disease in the NHANES cycles from 2011-March 2020. Multivariable adjusted linear and logistic regression models were used for analysis. Results Among 2,059 Asian American individuals, the weighted mean LE8 score was 69.1 (0.4) with US-born [69.0 (0.8)] and foreign-born individuals [69.1 (0.4)] having similar CVH. From 2011 to March 2020, CVH in the overall population [69.7 (0.8) to 68.1 (0.8); Ptrend: 0.009] and foreign-born individuals [69.7 (0.8) to 67.7 (0.8); Ptrend: 0.005] declined. Decreasing trends were noted in the body mass index score irrespective of stratification and in the blood pressure scores in the overall population and foreign-born Asian American individuals. Compared with US-born individuals, the odds of ideal levels of smoking [ORadj:<5 years: 2.23 (95%CI: 1.45-3.44); 5-15 years: 1.97 (95%CI: 1.27-3.05); 15-30 years: 1.61 (95%CI: 1.11-2.34); ≥30 years: 1.69(95%CI:1.20-2.36)] and diet [ORadj: <5 years: 1.87 (95%CI: 1.26-2.79); 5-15 years: 2.00 (95%CI: 1.38-2.89); 15-30 years: 1.74 (95%CI: 1.14-2.68)] were higher in foreign-born individuals. Foreign-born individuals had lower odds of ideal physical activity levels [ORadj: 5-15 years: 0.55 (95%CI: 0.39-0.79); 15-30 years: 0.68 (95%CI: 0.49-0.95)] and ideal cholesterol levels [ORadj: 5-15 years: 0.59 (95%CI: 0.42-0.82); 15-30 years: 0.54 (95%CI :0.38-0.76); ≥30 years: 0.52 (95%CI: 0.38-0.76)]. Conclusion The CVH in Asian American individuals declined from 2011 to March 2020. The odds of ideal CVH decreased with increasing duration of stay in the US, with foreign-born individuals residing in the US for ≥30 years having ∼28% lower odds of ideal CVH compared with US-born individuals.
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Affiliation(s)
- Naman S. Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mokshad Gaonkar
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States of America
| | - Peng Li
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory Pavela
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Waitzfelder B, Palaniappan L, Varga A, Frankland TB, Li J, Daida YG, Kaholokula JK, Bacong AM, Rawlings AM, Chung S, Howick C, Fortmann SP. Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai'i and California. BMC Public Health 2023; 23:885. [PMID: 37189145 PMCID: PMC10184427 DOI: 10.1186/s12889-023-15795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations. METHODS The study cohort was comprised of all adult patients at Kaiser Permanente Hawai'i and Palo Alto Medical Foundation in California during 2014-2018 (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups. RESULTS The prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos). CONCLUSIONS Study findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.
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Affiliation(s)
- Beth Waitzfelder
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Timothy B Frankland
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Jiang Li
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, CA, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | | | - Andreea M Rawlings
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | | | - Connor Howick
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA.
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25
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Kandula NR, Islam N, Needham BL, Ahmed N, Thorpe L, Kershaw KN, Chen E, Zakai NA, Kanaya AM. A multilevel framework to investigate cardiovascular health disparities among South Asian immigrants in the United States. Ann Epidemiol 2023; 81:24-30.e1. [PMID: 36898570 PMCID: PMC10101928 DOI: 10.1016/j.annepidem.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Prior studies of cardiovascular health (CVH) disparities among immigrants of South Asian origin in the United States have examined South Asians as one homogenous group, focused primarily on Indian-origin immigrants, and examined risk at the individual level. METHODS We present current knowledge and evidence gaps about CVH in the three largest South Asian-origin populations in the United States-Bangladeshi, Indian, and Pakistani-and draw on socioecological and lifecourse frameworks to propose a conceptual framework for investigating multilevel risk and protective factors of CVH across these groups. RESULTS The central hypothesis is that CVH disparities among South Asian populations exist due to differences in structural and social determinants, including lived experiences like discrimination, and that acculturation strategies and resilience resources (e.g., neighborhood environment, education, religiosity, social support) ameliorate stressors to act as health protective factors. RESULTS Conclusions: Our framework advances conceptualization of the heterogeneity and drivers of cardiovascular disparities in diverse South Asian-origin populations. We present specific recommendations to inform the design of future epidemiologic studies on South Asian immigrant health and the development of multilevel interventions to reduce CVH disparities and promote well-being.
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Affiliation(s)
- Namratha R Kandula
- Department of Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL; Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL.
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor
| | - Naheed Ahmed
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Lorna Thorpe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL
| | - Edith Chen
- Institute for Policy Research and Department of Psychology, Northwestern University, Chicago, IL
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington; Department of Pathology & Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington
| | - Alka M Kanaya
- Department of Medicine, Epidemiology & Biostatistics, University of California, San Francisco
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26
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Deshpande A, Shah NS, Kandula NR. Obesity and Cardiovascular Risk among South Asian Americans. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:73-82. [PMID: 37009309 PMCID: PMC10063226 DOI: 10.1007/s12170-023-00714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 02/05/2023]
Abstract
Purpose of review South Asian Americans experience higher cardiometabolic risk and disproportionately high rates of cardiovascular disease (CVD) compared to other racial and ethnic groups in the United States. The purpose of this review is to summarize recent evidence about the role of obesity in CVD risk in South Asian Americans and identify key evidence gaps and future directions for research and interventions for obesity in this group. Recent findings South Asian Americans are predisposed to abdominal obesity and have a higher distribution of visceral fat, intermuscular fat, and intrahepatic fat compared to adults of other race and ethnic groups. In this population, the risk for cardiometabolic disease appears to be elevated even at a normal body mass index. Social, cultural, religious, interpersonal, and environmental factors are related to obesity and obesity-related behaviors among South Asian Americans. Summary There is a relatively high prevalence of obesity in South Asian-origin populations in the United States, who have unique socio-cultural determinants of overweight and obesity. Future research should clarify why the risk for metabolic disease and CVD is elevated at normal BMI in the South Asian American population, and environmental and other structural factors that may influence obesity in this group. Interventions must be adapted to the social and cultural context of South Asian Americans to improve effectiveness and implementation.
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Affiliation(s)
| | - Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Namratha R. Kandula
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medicine (General Internal Medicine), Northwestern University Feinberg School of Medicine, Chicago, IL
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27
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Agarwala A, Satish P, Al Rifai M, Mehta A, Cainzos-Achirica M, Shah NS, Kanaya AM, Sharma GV, Dixon DL, Blumenthal RS, Natarajan P, Nasir K, Virani SS, Patel J. Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S. JACC. ADVANCES 2023; 2:100258. [PMID: 38089916 PMCID: PMC10715803 DOI: 10.1016/j.jacadv.2023.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/20/2023]
Abstract
South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.
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Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Anurag Mehta
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona, Spain
- Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Garima V. Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Dave L. Dixon
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cardiovascular Research Center Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1122] [Impact Index Per Article: 1122.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Social Determinants of Health, Cardiovascular Risk Factors, and Atherosclerotic Cardiovascular Disease in Individuals of Vietnamese Origin. Am J Cardiol 2023; 189:11-21. [PMID: 36481374 DOI: 10.1016/j.amjcard.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/01/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
In 2022, the Vietnamese population in the United States (US) comprises 2.2 million individuals, and Vietnam ranks as the sixth most frequent country of origin among immigrants in the US. The American Heart Association and the National Institutes of Health have called for research to define the burden of cardiovascular risk factors, cardiovascular disease, and their determinants across Asian American subgroups, including Vietnamese Americans. Despite these calls, Vietnamese Americans remain remarkably overlooked in cardiovascular research in the US. Studies in Vietnam, small cross-sectional surveys in the US, and research using US mortality data point to a high prevalence of hypertension and tobacco use among men and a high incidence of gestational diabetes among women. Moreover, Vietnamese Americans have one of the highest rates of cerebrovascular mortality in the country. Adverse social determinants of health-including frequent language barriers, limited health literacy, and low average income-have been suggested as important factors that contribute to cardiovascular risk in this group. In this narrative review, we summarize the existing knowledge in this space, highlight the distinct characteristics of cardiac risk in both Vietnamese and Vietnamese American individuals, discuss upstream determinants, and identify key knowledge gaps. We then outline several proposed interventions and emphasize the need for further studies in this underrepresented population. Our aim is to increase awareness of the significant burden of risk factors and cardiovascular disease shouldered by this large-but thus far overlooked-population in the US, boost research in this space, and help inform tailored, effective preventive interventions.
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30
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Shah NS, Huang X, Petito LC, Bancks MP, Ning H, Cameron NA, Kershaw KN, Kandula NR, Carnethon MR, Lloyd-Jones DM, Khan SS. Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health in the United States Population. Circulation 2023; 147:190-200. [PMID: 36334260 PMCID: PMC9852071 DOI: 10.1161/circulationaha.122.061991] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the NHANES (National Health and Nutrition Examination Surveys) 2011 to 2018, to inform strategies to mitigate CVH inequities. METHODS In NHANES participants ages ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range, 0-14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults. RESULTS Among 16 172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among men, mean (SE) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among men (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in non-Hispanic Asian, and 0.23 [0.03] points higher in non-Hispanic Black participants; P<0.05). Among women, mean (SE) CVH score was 8.03 (2.4) in Hispanic, 9.34 (2.1) in non-Hispanic Asian, 7.43 (2.3) in non-Hispanic Black, and 8.00 (2.5) in non-Hispanic White adults. Education explained the largest component of CVH difference in non-Hispanic Black women (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.17 [0.03] points higher in non-Hispanic Black participants; P<0.05). Place of birth (born in the United States versus born outside the United States) explained the largest component of CVH difference in Hispanic and non-Hispanic Asian women (if distribution of place of birth were similar to non-Hispanic White participants, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively; P<0.05). CONCLUSIONS Education and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults.
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Affiliation(s)
- Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xiaoning Huang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lucia C. Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael P. Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Natalie A. Cameron
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Namratha R. Kandula
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald M. Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Patel J, Agarwala A, Bhatt DL. A Message From the Next Generations: I Believe in You-Take Control of Your Health. JACC. ADVANCES 2023; 2:100168. [PMID: 38939025 PMCID: PMC11198238 DOI: 10.1016/j.jacadv.2022.100168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Jaideep Patel
- South Asian Cardiovascular Health Initiative (SACHI) for the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
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Abrahamowicz AA, Ebinger J, Whelton SP, Commodore-Mensah Y, Yang E. Racial and Ethnic Disparities in Hypertension: Barriers and Opportunities to Improve Blood Pressure Control. Curr Cardiol Rep 2023; 25:17-27. [PMID: 36622491 PMCID: PMC9838393 DOI: 10.1007/s11886-022-01826-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW To characterize the barriers and opportunities associated with racial and ethnic disparities in blood pressure (BP) control. RECENT FINDINGS Blood pressure (BP) control rates in the USA have worsened over the last decade, with significantly lower rates of control among people from racial and ethnic minority groups, with non-Hispanic (NH) Black persons having 10% lower control rates compared to NH White counterparts. Many factors contribute to BP control including key social determinants of health (SDoH) such as health literacy, socioeconomic status, and access to healthcare as well as low awareness rates and dietary habits. Numerous pharmacologic and non-pharmacologic interventions have been developed to reduce racial and ethnic disparities in BP control. Among these, dietary programs designed to help reduce salt intake, faith-based interventions, and community-based programs have found success in achieving better BP control among people from racial and ethnic minority groups. Disparities in the prevalence and management of hypertension persist and remain high, particularly among racial and ethnic minority populations. Ongoing efforts are needed to address SDoH along with the unique genetic, social, economic, and cultural diversity within these groups that contribute to ongoing BP management inequalities.
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Affiliation(s)
| | - Joseph Ebinger
- Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Eugene Yang
- Division of Cardiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356005, Seattle, WA, 98195, USA.
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Cardiovascular risk-enhancing factors and coronary artery calcium in South Asian American adults: The MASALA study. Am J Prev Cardiol 2022; 13:100453. [PMID: 36636125 PMCID: PMC9830105 DOI: 10.1016/j.ajpc.2022.100453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives The 2018 and 2019 U.S. guidelines for the management of cholesterol and primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of cardiovascular risk-enhancing factors (REFs), including South Asian ancestry, to refine ASCVD risk estimation. However, the associations of REFs with atherosclerosis are unclear in South Asian American adults, who have a disproportionately elevated premature coronary heart disease risk. In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we investigated associations of individual REFs, or the number of REFs, with coronary artery calcium (CAC). Methods Using baseline and follow-up data from MASALA, we evaluated the association of REFs (family history of ASCVD, low-density lipoprotein cholesterol ≥160 mg/dL, triglycerides ≥175 mg/dL, lipoprotein(a) >50 mg/dL, high-sensitivity C-reactive protein [hsCRP] ≥2.0 mg/dL, ankle-brachial index <0.9, chronic kidney disease, metabolic syndrome), individually and combined, with baseline prevalent CAC, any CAC progression (including incident CAC and CAC progression), and annual CAC progression rates using multivariable logistic regression and generalized linear models. Results Among 866 adults, mean age was 55 [SD 9] years and 47% were female. There were no significant associations of REFs with baseline prevalent CAC or any CAC progression (incident CAC and CAC progression at Exam 2) after adjustment. Among the 56% of participants who had any CAC progression, having 3+ REFs was associated with a significantly higher annual CAC progression rate (adjusted rate ratio [aRR] 1.94, 95% CI 1.39-2.72) vs. having 0 REFs. The annual CAC progression rate was 20% higher per additional REF (aRR 1.20, 95% CI 1.09-1.32). Findings were similar after excluding statin users, and among those with low 10-year ASCVD risk (<5%). Conclusions Among South Asian American adults, we found no association of REFs with prevalent CAC at baseline or having any CAC progression. Among those with any CAC progression, a higher number of REFs was associated with higher annual CAC progression rates.
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Association of Acculturation with Cardiovascular Risk Factors in Asian-American Subgroups. Am J Prev Cardiol 2022; 13:100437. [PMID: 36545389 PMCID: PMC9761380 DOI: 10.1016/j.ajpc.2022.100437] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This cross-sectional study aims to better understand the heterogeneous associations of acculturation level on CV risk factors among disaggregated Asian subgroups. We hypothesize that the association between acculturation level and CV risk factors will differ significantly by Asian subgroup. Methods We used the National Health Interview Survey (NHIS), a nationally representative US survey, years 2014-18. Acculturation was defined using: (a) years in the US, (b) US citizenship status, and (c) level of English proficiency. We created an acculturation index, categorized into low vs. high (scores of 0-3 and 4, respectively). Self-reported CV risk factors included diabetes, high cholesterol, hypertension, obesity, tobacco use, and sufficient physical activity. Rao-Scott Chi Square was used to compare age-standardized, weighted prevalence of CV risk factors between Asian subgroups. We used logistic regression analysis to assess associations between acculturation and CV risk factors, stratified by Asian subgroup. Results The study sample consisted of 6,051 adults ≥ 18 years of age (53.9% female; mean age 46.6 [SE 0.33]). The distribution by race/ethnicity was Asian Indian 26.9%, Chinese 22.8%, Filipino 18.1%, and other Asian 32.3%. The association between acculturation and CV risk factors differed by Asian subgroups. From multivariable adjusted models, high vs. low acculturation was associated with: high cholesterol amongst Asian Indian (OR=1.57, 95% CI: 1.11, 2.37) and other Asian (OR=1.48, 95% CI: 1.10, 2.01) adults, obesity amongst Filipino adults (OR= 1.62, 95% CI: 1.07, 2.45), and sufficient physical activity amongst Chinese (OR= 1.54, 95% CI: 1.09, 2.19) and Filipino adults (OR=1.58, 95% CI: 1.10, 2.27). Conclusion This study demonstrates that acculturation is heterogeneously associated with higher prevalence of CV risk factors among Asian subgroups. More studies are needed to better understand these differences that can help to inform targeted, culturally specific interventions.
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Gupta K, Al Rifai M, Hussain A, Minhas AMK, Patel J, Kalra D, Samad Z, Virani SS. South Asian ethnicity: What can we do to make this risk enhancer a risk equivalent? Prog Cardiovasc Dis 2022; 75:21-32. [PMID: 36279943 DOI: 10.1016/j.pcad.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
South Asians account for around 25% of the global population and are the fastest-growing ethnicity in the US. This population has an increasing burden of atherosclerotic cardiovascular disease (ASCVD) which is also seen in the diaspora. Current risk prediction equations underestimate this risk and consider the South Asian ethnicity as a risk-enhancer among those with borderline-intermediate risk. In this review, we discuss why the South Asian population is at a higher risk of ASCVD and strategies to mitigate this increased risk.
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Affiliation(s)
- Kartik Gupta
- Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Mahmoud Al Rifai
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Aliza Hussain
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Jaideep Patel
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Dinesh Kalra
- Rudd Heart & Lung Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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Guduguntla V, Durant RW. Lessons From Asian Subgroups About Disparities in Ischemic Heart Disease-Improving Studies of Minority Health. JAMA Intern Med 2022; 182:1103-1104. [PMID: 36036922 DOI: 10.1001/jamainternmed.2022.3620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Vinay Guduguntla
- Department of Medicine, University of California, San Francisco.,Editorial Fellow, JAMA Internal Medicine
| | - Raegan W Durant
- Division of Preventive Medicine, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham.,Associate Editor, JAMA Internal Medicine
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Shah NS, Palaniappan LP, Khan SS. Proportional Mortality From Ischemic Heart Disease Among Asian American Subgroups, From 2018 to 2020. JAMA Intern Med 2022; 182:1101-1103. [PMID: 36036927 PMCID: PMC9425281 DOI: 10.1001/jamainternmed.2022.3616] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022]
Abstract
This cross-sectional study examines the percentage of deaths attributed to ischemic heart disease by age and sex of Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese decedents.
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Affiliation(s)
- Nilay S. Shah
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Latha P. Palaniappan
- Department of Medicine (Primary Care and Population Health), Stanford University School of Medicine, Stanford, California
| | - Sadiya S. Khan
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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