Burden of cardiovascular risk factors and disease in five Asian groups in Catalonia: a disaggregated, population-based analysis of 121 000 first-generation Asian immigrants

Abstract

Aims To evaluate the burden of cardiovascular risk factors and disease (CVD) among five Asian groups living in Catalonia (Spain): Indian, Pakistani, Bangladeshi, Filipino, and Chinese. Methods and results Retrospective cohort study using the Catalan Health Surveillance System database including 42 488 Pakistanis, 40 745 Chinese, 21 705 Indians, 9544 Filipinos, and 6907 Bangladeshis; and 5.3 million native individuals (‘locals’). We estimated the age-adjusted prevalence (as of 31 December 2019) and incidence (during 2019) of diabetes, hypertension, hyperlipidaemia, obesity, tobacco use, coronary heart disease (CHD), cerebrovascular disease, atrial fibrillation, and heart failure (HF). Bangladeshis had the highest prevalence of diabetes (17.4% men, 22.6% women) followed by Pakistanis. Bangladeshis also had the highest prevalence of hyperlipidaemia (23.6% men, 18.3% women), hypertension among women (24%), and incident tobacco use among men. Pakistani women had the highest prevalence of obesity (28%). For CHD, Bangladeshi men had the highest prevalence (7.3%), followed by Pakistanis (6.3%); and Pakistanis had the highest prevalence among women (3.2%). For HF, the prevalence in Pakistani and Bangladeshi women was more than twice that of locals. Indians had the lowest prevalence of diabetes across South Asians, and of CHD across South Asian men, while the prevalence of CHD among Indian women was twice that of local women (2.6% vs. 1.3%). Filipinos had the highest prevalence of hypertension among men (21.8%). Chinese men and women had the lowest prevalence of risk factors and CVD. Conclusions In Catalonia, preventive interventions adapted to the risk profile of different Asian immigrant groups are needed, particularly for Bangladeshis and Pakistanis.

Implications of the 2021 ESC Cardiovascular Risk Classification among 283,000 European Immigrants Living in a Low-Risk Region: A Population-Based Analysis in Catalonia

“…Nevertheless, recent analyses in Catalonia using the CHSS database focused on Asian populations yielded remarkably consistent findings with those observed in the UK. [14][15][16] This provides further reassurance with regards to the internal and external validity of our findings. Finally, information on length of stay in Catalonia was not available, which precluded accounting for this variable in the analyses, as well as evaluating the extent and effect of Mediterranean acculturation.…”

“…We had also provided reassurance regarding the fact that the number of undocumented immigrants who would not be detected in the CHSS database is expected to be low in Catalonia given universal healthcare coverage, including for undocumented immigrants. 14,22,35 The generalizability of our findings to other countries is unknown. Nevertheless, recent analyses in Catalonia using the CHSS database focused on Asian populations yielded remarkably consistent findings with those observed in the UK.…”

“…S2 presents the specific ICD codes used to identify each of these risk factors and conditions, which were consistent with the definitions previously used by our group and others. 14…”

Implications of the 2019 American College of Cardiology/American Heart Association Primary Prevention Guidelines and potential value of the coronary artery calcium score among South Asians in the US: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study

“…US SAs represent on average a highly educated and high-income SA subgroup [33,34]. Moreover, the majority are of Indian origin, and international studies suggest that Indians comprise a lower-risk SA subgroup compared to people from Pakistan and Bangladesh [35][36][37]. Consistent with these trends, the population included in the initial MASALA study also comprised a wealthy, highly educated, mostly Indian SA cohort [21,22].…”

Association of U.S. birth, duration of residence in the U.S., and atherosclerotic cardiovascular disease risk factors among Asian adults

“…For example, the prevalence of diabetes mellitus was highest among Filipinos up until 10 years after which the prevalence was highest among Asian Indians. Indeed, Asian Indians are prone to developing diabetes mellitus, ( Narayan and Kanaya, 2020 , Satish et al, 2021 , Kanaya et al, 2014 , Patel et al, 2021 ) and this risk may increase with longer time spent living in the U.S.…”