Hispanic Women's Hearts at High Risk
Hispanic women develop cardiac risk factors much earlier than white women, typically exhibiting the heart health of a white woman 10 years older, a new study finds.
The research suggests that being Hispanic may be an independent risk factor for heart disease, and that these women need to be identified and treated earlier.
"The tendency for medical practice is to assume that Hispanics have a delayed onset or less prevalence of cardiac disease, and our study shows that they have earlier onset and the same risk as Caucasians," said study author Dr. John Teeters, a cardiology fellow at the University of Rochester Medical Center in Rochester, N.Y.
"Physicians should be more aggressively targeting this population for identification of risk factors such as cholesterol and obesity and recognizing that a 20- or 30-year-old Hispanic may have the same risk factors as a 30- or 40-year-old Caucasian," he said.
Teeters was to present the findings Friday at the American Heart Association's annual conference on Cardiovascular Disease Epidemiology and Prevention, in Orlando, Fla.
The findings turn the so-called "Hispanic Paradox" on its head. This medical notion has long held that Hispanics have less heart disease than whites do, despite having higher rates of risk factors.
But Teeters and his colleagues found that Hispanic women have earlier onset of disease, more risk factors, and an equal, if not higher, risk of cardiac disease.
"We did the study because the literature shows that the risk is less. But, in actual clinical practice, Hispanic patients are coming in with a lot of risk factors," he said. In other words, there appeared to be a wide gap between theory and practice.
For this study, the researchers conducted a series of free community health screenings at churches, community centers and outpatient clinics that primarily serve Hispanics. The outreach clinics were funded by Pfizer Inc., the pharmaceutical giant, but Pfizer did not fund data analysis or contribute to presentation of the data, the authors stated.
Medical histories were collected for 79 Hispanic women, along with measurements of blood pressure, body mass index, waist circumference, lipid profiles and blood sugar.
A group of 91 white women served as the control group. The average age of the Hispanic women was 53 vs. 63 in the white group. Only 61 percent of the Hispanic women were postmenopausal, compared with 85 percent of the white women.
Despite age differences and differences in menopausal status, heart disease risk for the two ethnic groups was about the same.
Hispanic women had a higher rate of pre-hypertension (32 percent) compared with white women (19 percent). Physical activity levels for Hispanic women were significantly lower and they had a slightly higher rate of metabolic syndrome, a cluster of risk factors that predispose a person towards cardiovascular disease.
Scores for hypertension, diabetes, high cholesterol and waist circumference were similar between the two groups.
"I thought the findings were shocking," said Dr. Suzanne Steinbaum, director of women and heart disease and the Heart & Vascular Institute at Lenox Hill Hospital in New York City. "We have to find out what about Hispanic women is leading to this increased risk of heart disease."
"Hispanic women need to get checked earlier because their risk is earlier," Steinbaum added. "Hispanic women in their 20s really need to have an exam. Pre-hypertension needs to be looked for and treated early."
What, then, explains the wide acceptance among clinicians of the Hispanic Paradox?
Teeters believes that the Hispanic Paradox may have resulted from incomplete data. "Hispanic patients are less likely to come to care, so there's probably under-recognition of the degree of disease," Teeters said. "Many are immigrants and many go home when they become ill. There's also a higher degree of illegal alien status so there''s probably underreporting."
Teeters and his team are now expanding their research to look at black Americans, who are expected to be another high-risk group. They also want to see if they can affect cardiac risk in high-risk groups by treating risk factors more aggressively earlier.