The Risk of Ischemic Heart Disease and Stroke Among Immigrant Populations: A Systematic Review

Understanding the Healthy Immigrant Effect and Cardiovascular Disease

“…Notably, traditional cardiovascular risk factors had a small role in explaining the protective effect of foreign nativity or the heterogeneity. The CANHEART findings align with a growing body of previous research documenting similar patterns, whereby foreign nativity (in comparison with the native-born population) is protective for health across different outcomes 3 including CVD, 4 particularly in North America. The article by Tu et al accomplishes 2 important goals.…”

“…The results of the study by Tu et al are consistent with others showing that the protective effect of foreign nativity is not explained fully by proximate risk factors. Like many studies documenting a protective effect of foreign nativity, 4,7 Tu et al invoke selection as a primary explanation for the patterns observed. The logic of the selection explanation for the HIE is very compelling: migrants who choose to and successfully emigrate may be healthier than those left behind (healthy migrants), because of self-selection or physical or legal barriers to entering the receiving country.…”

“…5 The study by Tu et al also contributes to a growing body of literature revealing heterogeneous patterns in CVD risk across receiving and sending country combinations. 4 This heterogeneity is not terribly surprising given the diversity of immigrant sending countries (and population health patterns across these countries) and the historic and geopolitical specificity of many immigrant flows to destination countries. Still, this information on heterogeneity is valuable for future studies, enabling the comparison of outcomes among immigrants of multiple countries of origin residing in the same host country, with some precision.…”

“…Previous studies of CVD among immigrants have varied in the definition of both immigrant (eg, regarding nativity, legal status, and long-term status) and the reference group in terms of inclusion of second-or higher-generation immigrants, or restriction to the dominant host population. 4 Studies that allow comparisons of health patterns between the foreign-born and native-born counterparts (eg, second-or higher-generation immigrants from the same region or country of origin) 6 may ultimately be most informative for understanding the long-term and heterogeneous trajectories of immigrants from different countries of origin. This is especially critical given consistent evidence that the protective health status associated with immigration is not sustained intergenerationally.…”

Association of Birthplace and Coronary Heart Disease and Stroke Among US Adults: National Health Interview Survey, 2006 to 2014

“…In Canada, a large cohort study of first‐generation adult immigrants from different global regions found 30% lower 10‐year age‐standardized incidence of major cardiovascular disease among immigrants compared with long‐term Canadian residents . In general, immigrants from Eastern European, South Asian, and Middle Eastern countries had higher risk of CHD and stroke than long‐term Canadian residents . In addition, immigrants from East Asia had the lowest incidence of cardiovascular disease, whereas immigrants from South Asia had the highest incident rates in the same study .…”