Cardiovascular Disease Risk Factors High in Minority Populations

While most Hispanic and Latino people in the US were aware of their cardiovascular disease risk factors, less than half of stroke survivors in these populations had healthy blood pressure and cholesterol, according to a study published in Stroke, an American Heart Association (AHA) journal.

About half of adults with history of stroke of transient ischemic attack (TIA) had healthy blood sugar levels.

AHA reports that from 2015 to 2018, 52.3 percent of Hispanic men and 42.7 percent of Hispanic women aged 20 years and older has cardiovascular disease.

“It’s a wake-up call for the medical community. Despite our best efforts, Hispanic and Latino populations still seem to be undertreated for their vascular risk factors,” said Fernando D. Testai, MD, PhD, FAHA, study co-author and an associate professor of neurology at the University of Illinois at Chicago.

“I didn’t expect the numbers to be so dismal. We found many of the participants with previous stroke knew about their vascular risk factors; however, the data indicate they are receiving inadequate treatment and support, which are a real concern.”

For the study, researchers analyzed data from Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a longitudinal study of the health of people of Cuban, Dominican, Mexican, Puerto Rican, and Central and South American background.

Between 2008 and 2011, more than 16,000 participants ages 18 to 74 completed questionnaires about their health and were examined at one of four centers in Chicago, the Bronx, Miami, and San Diego.

Drawing from the HCHS/SOL dataset, the team focused on data for 404 adults who had a self-reported history of stroke or TIA. Researchers explored the rate of high blood pressure, diabetes, and high cholesterol, and assessed whether the 404 study participants knew that they had these major cardiovascular risk factors as well as the treatment status for these chronic conditions. The group also asked participants whether they were taking medications to prevent a second stroke.

The results showed that overall, 59 percent of participants had high blood pressure, 65 percent had high cholesterol, and more than one-third had diabetes.

Although up to 90 percent of participants knew they had these risk factors, not many had healthy levels: Almost half had normal blood pressure levels, one-third had healthy cholesterol levels, and about half had their blood sugar in the healthy range.

About half of participants were taking anti-clotting medications, less than half were taking cholesterol-lowering statin medications, and one-quarter were taking both medications. The team also found that older age was associated with uncontrolled blood pressure and diabetes, and that adults born in the US or who have lived in the US more than ten years were more likely to have poorly controlled diabetes.

Additionally, women were more likely to have unhealthy cholesterol levels, and not having health insurance was associated with decreased statin use and unhealthy cholesterol levels.

“Healthcare professionals can help inform and support Hispanic/Latino adults about the importance of adopting healthy lifestyle behaviors in order to reduce cardiovascular risk,” Testai said.

“Almost 80 percent of people in this study were overweight or obese, and a significant number continued to smoke despite having a history of stroke and other cardiovascular events. Access to care is another important area that we need to address to reduce cardiovascular risk in this population.”

In this analysis, researchers referenced older guidelines with higher thresholds for unhealthy blood pressure and cholesterol levels.

“We were conservative in our goals. If we used the newer goals, which are far more stringent, the results would be even more alarming,” Testai said.

The study was limited in that HCHS/SOL data was self-reported by participants. Additionally, while race was self-reported, social determinants of health and health impacts of structural racism were not accounted for in this analysis.

Despite these limitations, researchers believe that the study highlights the need for targeted prevention programs in Hispanic and Latino populations to help individuals avoid a second stroke and other events. This could be especially beneficial in older adults, women, the uninsured, and those born or living in the US for more than ten years.

“Hispanic/Latino adults in the United States have high prevalence and awareness of vascular risk factors but low adherence to secondary stroke prevention strategies. Older adults, women, and uninsured people are vulnerable groups that may benefit from targeted interventions,” the team concluded.

This study adds to AHA’s recent efforts to better understand health disparities and gaps in care. In new guidance published in Circulation: Cardiovascular Quality and Outcomes, another AHA journal, researchers challenged the scientific community to methodically examine structural factors including racism when studying racial and ethnic disparities in health.

“For too long, racial and ethnic disparities in healthcare quality and outcomes reported by researchers in scientific journals have attributed such differences to individual factors or local systems with less attention paid to the underlying role of societal factors,” researchers wrote.

“Yet health equity will likely remain out of reach if such methods to understand and intervene upon racial and ethnic disparities do not intentionally address entrenched systematic challenges, such as structural racism.”