CVD mortality differed in Asian-American subgroups

CVD mortality appears to differ in Asian-American subgroups and has not declined in those groups as fast as it has for non-Hispanic white Americans, according to a study of death records.

The data suggest that “the messages on prevention and management of CVD are not effectively reaching this population,” the researchers wrote. “The lack of national mortality statistics for CVD among Asian Americans has made it difficult to recommend research agendas, to create public health policy, and to offer appropriate clinical guidelines.”

Powell O. Jose, MD, and colleagues examined CVD and stroke mortality rates from 2003 to 2010 in the six largest Asian-American subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean and Vietnamese.

Using death record data for 10,442,034 people, as well as US Census Bureau data, the researchers calculated standardized mortality ratios, relative standardized mortality ratios and proportional mortality rates for each sex and ethnic group compared with non-Hispanic whites.

Jose, from Palo Alto Medical Foundation Research Institute, Palo Alto, Calif., and colleagues found that total deaths and mean mortality rates from CVD and all CVD types were higher in non-Hispanic white men and women compared with men and women of all Asian-American subgroups.

However, proportionate mortality ratios for ischemic heart disease were higher in Asian-Indian men (1.43) and Filipino men (1.15) compared with non-Hispanic white men (1.08), and in Asian-Indian women (1.12) compared with non-Hispanic white women (0.92).

Hypertensive disease

In other results, every Asian-American subgroup except for Vietnamese had greater proportionate mortality from hypertensive disease compared with non-Hispanic whites (men: Filipino, 1.38; Chinese, 1.27; Asian Indian, 1.18; Japanese, 0.95; Korean, 0.95; Vietnamese, 0.9; non-Hispanic white, 0.9; women: Chinese, 1.69; Filipino, 1.5; Asian Indian, 1.46; Korean, 1.3; Japanese, 1.23; non-Hispanic white, 1.1; Vietnamese, 0.95).

All Asian-American subgroups had lower proportionate mortality ratios for HF compared with non-Hispanic whites.

According to the researchers, the standardized mortality rate from all CVD declined each year of the study period for non-Hispanic white men and women, but the slope of the decline was less for all Asian-American subgroups, and the standardized mortality rate increased from 2003 to 2010 for Asian Indian men and women.

For cerebrovascular disease, non-Hispanic white women had higher age-standardized mortality rates vs. women from all Asian-American subgroups, but Filipino men (65.33), Japanese men (56.57) and Vietnamese men (51.93) had higher age-standardized mortality rates compared with non-Hispanic white men (50.3), the researchers found.

Although non-Hispanic white men and women had the highest mortality rates for ischemic stroke, all Asian-American subgroups except Asian Indians had higher mortality rates and greater proportionate mortality than non-Hispanic whites for hemorrhagic stroke.

“The higher proportionate mortality from hypertensive disease and hemorrhagic stroke among every Asian-American subgroup should prompt the need to evaluate and address hypertension treatment and control further in Asian-American populations,” the researchers wrote.

Broad categorizations not helpful

In a related editorial, Russell J. de Souza, ScD, RD, and Sonia S. Anand, MD, PhD, wrote that the study “emphasizes the substantial differences in cause-specific mortality and across subgroups of Asians and underscores the need for finer categorizations of race and ethnicity in population health studies. Broad categorizations such as ‘Asian’ may obscure important differences in risk factor frequency.”

De Souza and Anand, both from McMaster University, Hamilton, Ontario, Canada, also noted that “development of national prevention guidelines specifically directed toward Asian-American subgroups is needed.”

For more information:

de Souza RJ. J Am Coll Cardiol. 2014;64:2486-2494.

Jose PO. J Am Coll Cardiol. 2014;64:2495-2497.

Disclosure: The study was supported by a grant from the National Institute on Minority Health and Health Disparities. The researchers, Anand and de Souza report no relevant financial disclosures.