Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States

Abstract

Objective The Asian American population in the U.S. comprises various, ethnically diverse subgroups. Traditionally, this population has been studied as a single, aggregated group, potentially masking differences in risk among subgroups. Analyses using disaggregated data can help better characterize the health needs of different Asian subpopulations and inform targeted, effective public health interventions. We assessed the prevalence of cardiovascular disease (CVD) risk factors and atherosclerotic CVD (ASCVD) and their associations with socioeconomic factors among Chinese, Asian Indian, Filipino and Other Asian subjects, compared with non-Hispanic White (NHW) subjects in the U.S. Methods : Cross-sectional study using data from 298,286 adults from the National Health Interview Survey (NHIS) from 2007 to 2018. We utilized chi-squared tests to compare characteristics across subgroups. Weighted proportions and unadjusted and adjusted logistic regression models were utilized to examine the associations between Asian subgroups, self-reported CVD risk factors and self-reported ASCVD, as well as between socioeconomic factors within each Asian subgroup. Results : Asian Indian subjects had the highest prevalence of diabetes (12.5%), while Filipino subjects had the highest prevalence of hyperlipidemia (27.7%), hypertension (29.8%) and obesity (19.8%). Despite this, the prevalence of self-reported ASCVD was lower in all Asian groups compared with NHWs. Chinese subjects had the lowest odds of having each of the CVD risk factors assessed. Conclusion : We found considerable heterogeneity in the distribution of risk factors as well as ASCVD among Asian subgroups in the US. Compared with health system or community-based reports, the prevalence of risk factors and ASCVD may be underestimated in some Asian NHIS subgroups. There is an urgent need for efforts to improve recruitment of Asian participants of heterogeneous socioeconomic backgrounds in national surveys, as well as to perform a thorough assessment of risk factors and disease in this population, not relying solely on self-report.

The psychosis metabolic risk calculator (PsyMetRiC) for young people with psychosis: International external validation and site-specific recalibration in two independent European samples

“…At present due to sample size limitations ethnicity is captured in three categories, yet this is likely to be an oversimplification. For example, there are clear differences in cardiometabolic risk among different Asian ethnic groups, 53 and between Black Africans and Black Caribbeans. 54 PsyMetRiC cannot at present capture those differences.…”

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

“…Prior studies have shown heterogeneity in cardiovascular risk factor profile among Asian subgroups with a trend towards higher prevalence of diabetes mellitus in Asian Indians, higher prevalence of hypertension among Filipinos, and generally low risk factor burden among Chinese. ( Satish et al, 2021 , Koirala et al, 2021 , Dong, 2021 ) These differences can likely be attributed to varying degrees of acculturation as a result of cultural practices, history, language, time prior to moving to the U.S. and biological factors that are unique to each ethnic group. ( Needham et al, 2017 , Lieber et al, 2001 , Vargas and Jurado, 2015 ) Indeed Asian ethnic groups have different predilections to acculturation (embracing host cultural norms including values, attitudes and beliefs) versus enculturation (resocialization to ethnic cultural norms) though using U.S. birth and duration of time spent in the U.S. as proxies may not fully capture the dimensions of these constructs.…”

“…( Gupta et al, 2002 , Zaman et al, 2001 , Mendis and Ekanayake, 1994 ) This inherent high risk may be exacerbated during the process of acculturation among Asian immigrants. ( Al-Sofiani et al, 2020 ) With the increasing number of individuals of Asian descent in the U.S. and heterogenous cardiovascular disease risk factor profiles among Asian Americans, ( Satish et al, 2021 , Rodriguez et al, 2019 ) there is a need to examine health disparities among various Asian subgroups using a racial and cultural framework ( Wong et al, 2019 ) that examines Asian American health within the context of cultural integration. This analysis may identify high-risk Asian American subgroups ( Palaniappan et al, 2010 ) and shed light on how acculturation in Asian individuals may be associated with cardiovascular risk factors and ASCVD.…”

Racial/Ethnic Disparities and Determinants of Sufficient Physical Activity Levels

“…To ascertain differences among NH Asians subgroups, multivariable-adjusted logistic regression models as above were used to study the association of Asian ethnic groups and sufficient physical activity (Chinese as reference given that they have a lower cardiovascular risk factor profile compared with other Asian groups 10 ).…”