According to current estimates, more than 53 million Hispanics live in the United States, constituting about 17% of the total U.S. population. Hispanic Americans are the fastest-growing racial or ethnic population in the country and are expected to make up about 30% of the total population by 2050. “Hispanics are a diverse ethnic population, varying in race, origin, immigration status, and other socioeconomic factors,” says Carlos J. Rodriguez, MD, MPH. “The diversity among U.S. Hispanics presents many challenges.”
Dr. Rodriguez says that Hispanics are a segment of the population that has been somewhat ignored in clinical research relating to cardiovascular disease (CVD). “We’re lacking comprehensive research data on the prevalence of risk factors for CVD among Hispanics,” he says. Only recently have national surveys started including more in-depth information pertaining to Hispanic Americans. Greater efforts have been made to specifically address CVD risk among U.S. Hispanics of late. This research has indicated that there is a sizeable burden of CVD risk factors among these individuals. More studies are still needed because Hispanics are the largest ethnic minority in the U.S. and are likely to significantly impact future healthcare costs.
A Comprehensive Review
There currently is no comprehensive resource about the cultural values and behavioral aspects that influence the promotion, prevention, and acceptance of heart health and treatment recommendations for Hispanics. To address some of the gaps in knowledge about the burden of CVD among Hispanics, the American Heart Association (AHA) released a scientific advisory on the status of CVD and stroke in Hispanic and Latino Americans. Published in Circulation, the document provides for the first time a comprehensive overview of the problem and emphasizes the importance of culturally appropriate healthcare for this patient population.
“Our research is intended to inform the entire cardiovascular community about the burden of CVD and stroke in Hispanics,” says Dr. Rodriguez, who chaired the writing group that developed the scientific advisory. “Heart disease is the leading cause of death for Hispanics, just as it is for the rest of the population.” However, studies suggest that Hispanics appear to be much less aware of this connection and their own unique risk factors.
The AHA writing group summarized findings from a variety of sources that focused on Hispanic populations. Several important differences in the cardiovascular health of Hispanics emerged with regard to the prevalence of ideal cardiovascular health (Table 1). In addition, research shows that Hispanics are twice as likely to be diagnosed with type 2 diabetes when compared with non-Hispanic whites. Hispanic youths also have higher smoking rates, and preschool-aged Hispanic children are four times more likely to be obese. Mexican Americans are more likely to be hospitalized for a heart attack and are twice as likely to have an ischemic stroke before age 60.
Wanted: Customized Approaches
“We have very little research on the risks of CVD and stroke among Hispanics, and most of what we have focuses on Mexican Americans,” Dr. Rodriguez says. “There is still much to learn about specific risks in the different types of Hispanic populations. As a whole, Hispanics are a complex, heterogeneous population with much diversity that often goes underappreciated. We need more data on specific subgroups and must then develop and implement customized approaches to improve cardiovascular health and improve treatment and prevention efforts.”
The AHA recommends that healthcare providers, researchers, and policymakers consider cultural values and beliefs , language, the impact of acculturation, and other factors when developing customized strategies (Table 2). Healthcare providers should be trained to provide culturally proficient healthcare to Hispanic Americans. The scientific advisory also recommends that educational programs be established to help Hispanics better recognize risk factors and warning signs of stroke and heart attack. Standardizing health research, electronic health records, and other surveillance systems to include Hispanic subgroups and increasing the Hispanic healthcare workforce are other recommended strategies.
“Given the large Hispanic population in the U.S., it’s critical that we pay more attention to these individuals so that we can continue our efforts to improve the health of the nation,” Dr. Rodriguez says. “We should be embracing efforts to include Hispanics in the cardiovascular health goals that have been set for the entire U.S.”
According to Dr. Rodriguez, the current knowledge about CVD and stroke risks among subgroups of Hispanics must continue to evolve. “Our scientific advisory is a first step toward gaining a better understanding of the problem,” he says. “The next step is to further enhance our understanding of biological, psychosocial, and environmental factors and how they relate to all the components of CVD and stroke. As we learn more about these factors, it’s hoped that this information will lead us toward better methods for reducing the burden of CVD and stroke in Hispanics.”
Rodriguez CJ, Allison M, Daviglus ML, et al. Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation. 2014 Jul 14 [Epub ahead of print]. Available at: http://circ.ahajournals.org/content/early/2014/07/14/CIR.0000000000000071.full.pdf+html.
Daviglus ML, Talavera GA, Avilés-Santa ML, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308:1775-1784.
Heidenreich PA, Trogdon JG, Khavjou OA, et al; on behalf of the American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Cardiopulmonary; Critical Care; Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123:933-944.
Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP, Hazuda HP. All-cause and cardiovascular mortality among Mexican-American and non-Hispanic White older participants in the San Antonio Heart Study: evidence against the “Hispanic paradox.” Am J Epidemiol. 2003;158:1048-1057.