CV risks and barriers to care exclusive to Hispanic adults require special consideration
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Hispanic individuals represent the fastest-growing ethnic group in the U.S., increasing from 9% of total census respondents in 1990 to 12.5% in 2000, according to a presenter.
On average, they are younger than non-Hispanic white individuals, but they have the lowest rate of health insurance and greater prevalence of obesity, diabetes and asthma.
“It is important to differentiate where these individuals are coming from,” Ileana L. Piña, MD, MPH, professor of medicine at Wayne State University, clinical professor of medicine at Central Michigan University and senior staff fellow and medical officer at the FDA Center for Devices and Radiological Health, said during her presentation at the American Society for Preventive Cardiology Congress on CVD Prevention. “Why? Because genetics are different and because they are not all integrated. You need to look at the history of migrations and the mix of natives and migrants such as Africans and Spanish, which tends to be a large mixture.”
Among Hispanics in the U.S., 66% are Mexican, 15% are Central and South American, 9% are Puerto Rican, 4% are Cuban and 6% identify as other.
According to the presentation, the median age of Mexican Americans in the U.S. is 24 years; the median age of Puerto Ricans is 27 years; for Central and South Americans, the median age is 28 years; and the median age for Cubans is 41 years. By 2050, approximately 16.4% of U.S. adults aged at least 65 years will be Hispanic individuals.
“Hispanics report fewer cases of heart disease, often with the same risk factors, and we call that the ‘Hispanic paradox,’” Piña, a member of the Cardiology Today Editorial Board, said. “My hypothesis is that this is related to age because the Hispanic population tends to be younger. But they also have a greater risk of obesity, diabetes and asthma.”
Factors for ideal health
Piña referenced an American Heart Association study (Virani SS, et al. Circulation. 2020;doi:10.1161/CIR.0000000000000757) that evaluated factors of ideal health among U.S. adults. These factors included BMI, physical activity, healthy diet score, cholesterol, BP and diabetes.
According to the presentation, very few Hispanic adults met the criteria for all six factors compared with Black, white and Asian individuals.
Piña also noted that Hispanic individuals had the lowest prevalence of meeting both aerobic and muscle strengthening guidelines compared with the overall age-adjusted population (18.7% among Hispanic adults vs. 24.3% overall).
She said aerobic and muscle strengthening is “another area where your patients can get a lot of good recommendations from you, and hopefully they will listen to you. Losing weight and activity go hand in hand to help each other out.”
Moreover, a greater proportion of Hispanic adults have diabetes (15.1% of men; 14.1% of women) compared with white (9.4% of men; 7.3% of women), Black (14.7% of men; 13.4% of women) and Asian (12.8% of men; 9.9% of women) individuals, she said.
Unmet needs in health care research and delivery
“We want to personalize medicine. We want to look at resources to collect the right evidence that we need. Hispanics have not really been included in clinical trials. The numbers are usually below 10%, and we don’t have a lot of Hispanic investigators,” Piña said during the presentation. “A lot of covariates never get measured and we need help in the health care system. We need to trust that the health care system data that we are getting is actually accurate.
“This is a very vulnerable group. Not only because of socioeconomic difficulties, but access to care and difficulties in language. Not every [Hispanic individual] is acculturated,” Piña said. “We are not putting providers in these communities who are Hispanic and truly bilingual. A lot of these populations want to go to their own neighborhoods and community centers and speak to clinicians and providers that speak their language, and this will continue to have a huge impact on health care cost as this population ages.”
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Piña IL. Newer Insights into Assessing Risk in Hispanic Patients. Presented at: American Society for Preventive Cardiology Congress on CVD Prevention; July 25-26, 2020 (virtual meeting).
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