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Heterogeneity in Cardiovascular Health among Asian American Subgroups: Risk Factors, Outcomes, Treatment and Prevention, and Future Research Opportunities

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Handbook of Asian American Health

Abstract

Cardiovascular disease (CVD), including heart and cerebrovascular diseases, represents a leading cause of death in Asian Americans as a group. Much of our knowledge of CVD in Asian Americans has been based on studies that have either grouped Asian Americans together, or examined one Asian American subgroup alone. However, research that has compared Asian American subgroups, suggest marked heterogeneity in the prevalence of CVD and its risk factors among various subgroups (e.g., higher prevalence of coronary artery disease for Asian Indians and Filipinos). In this chapter, we will present our current understanding of CVD in Asian Americans with respect to: disease definitions, prevalence and epidemiology, cultural and structural barriers to health care, lifestyle and prevention, and future directions for research.

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References

  • Allison, M. A., Criqui, M. H., McClelland, R. L., Scott, J. M., McDermott, M. M., Liu, K., et al. (2006). The effect of novel cardiovascular risk factors on the ethnic-specific odds for peripheral arterial disease in the Multi-Ethnic Study of Atherosclerosis (MESA). Journal of the American College of Cardiology, 48, 1190–1197.

    Article  Google Scholar 

  • Ayala, C., Croft, J. B., Greenlund, K. J., Keenan, N. L., Donehoo, R. S., Malarcher, A. M., et al. (2002). Sex differences in US mortality rates for stroke and stroke subtypes by race/ethnicity and age, 1995-1998. Stroke, 33, 1197–1201.

    Article  Google Scholar 

  • Barnes, P. M., Adams, P. F., & Powell-Griner, E. (2008). Health characteristics of the Asian adult population: United States, 2004-2006. Advance Data No., 394, 1–22.

    Google Scholar 

  • Benfante, R. (1992). Studies of cardiovascular disease and cause-specific mortality trends in Japanese-American men living in Hawaii and risk factor comparisons with other Japanese populations in the Pacific region: A review. Human Biology, 64, 791–805.

    Google Scholar 

  • Bild, D. E., Bluemke, D. A., Burke, G. L., Detrano, R., Roux, A. V. D., Folsom, A. R., et al. (2002). Multi-ethnic study of atherosclerosis: Objectives and design. American Journal of Epidemiology, 156, 871–881.

    Article  Google Scholar 

  • Bryant, L. L., Chin, N. P., Cottrell, L. A., Duckles, J. M., Fernandez, I. D., Garces, D. M., et al. (2010). Perceptions of cardiovascular health in underserved communities. Preventing Chronic Disease, 7, A30.

    Google Scholar 

  • Burchfiel, C. M., Sharp, D. S., Curb, J. D., Rodriguez, B. L., Hwang, L.-J., Marcus, E. B., et al. (1995). Physical activity and incidence of diabetes: The Honolulu heart program. American Journal of Epidemiology, 141, 360–368.

    Article  Google Scholar 

  • Canto, J. G., Taylor, H. A., Jr., Rogers, W. J., Sanderson, B., Hilbe, J., & Barron, H. V. (1998). Presenting characteristics, treatment patterns, and clinical outcomes of non-black minorities in the National Registry of Myocardial Infarction 2. American Journal of Cardiology, 82, 1013–1018.

    Article  Google Scholar 

  • Carlisle, D. M., Leake, B. D., & Shapiro, M. F. (1995). Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988. American Journal of Public Health, 85, 352–356.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2004). Disparities in premature deaths from heart disease-50 States and the District of Columbia, 2001. MMWR Morbidity and Mortality Weekly Report, 53, 121–125.

    Google Scholar 

  • Central Intelligence Agency. (2010). The world fact book. Retrieved December 14, 2010, from https://www.cia.gov/library/publications/the-world-factbook/index.html.

  • Choi, S., Rankin, S., Stewart, A., & Oka, R. (2008). Perceptions of coronary heart disease risk in Korean immigrants with type 2 diabetes. Diabetes Educator, 34, 484–492.

    Article  Google Scholar 

  • Coronado, G. D., Woodall, E. D., Do, H., Li, L., Yasui, Y., & Taylor, V. M. (2008). Heart disease prevention ­practices among immigrant Vietnamese women. Journal of Women’s Health, 17, 1293–1300.

    Article  Google Scholar 

  • Corrado, E., Rizzo, M., Coppola, G., Fattouch, K., Novo, G., Marturana, I., et al. (2010). An update on the role of markers of inflammation in atherosclerosis. Journal of Atherosclerosis and Thrombosis, 17, 1–11.

    Article  Google Scholar 

  • Cossrow, N., & Falkner, B. (2004). Race/ethnic issues in obesity and obesity-related comorbidities. The Journal of Clinical Endocrinology & Metabolism, 89, 2590–2594.

    Article  Google Scholar 

  • Criqui, M. H., Vargas, V., Denenberg, J. O., Ho, E., Allison, M., Langer, R. D., et al. (2005). Ethnicity and peripheral arterial disease: The San Diego population study. Circulation, 112, 2703–2707.

    Article  Google Scholar 

  • Davis, A. M., Vinci, L. M., Okwuosa, T. M., Chase, A. R., & Huang, E. S. (2007). Cardiovascular health disparities: A systematic review of health care interventions. Medical Care Research and Review, 64, 29S–100S.

    Article  Google Scholar 

  • Dawber, T. R., Meadors, G. F., & Moore, F. E., Jr. (1951). Epidemiological approaches to heart disease: The Framingham study. American Journal of Public Health Nations Health, 41 , 279–281.

    Article  Google Scholar 

  • Diamond, L. C., Wilson-Stronks, A., & Jacobs, E. A. (2010). Do hospitals measure up to the national culturally and linguistically appropriate services standards? Medical Care, 48, 1080–1087.

    Article  Google Scholar 

  • Eastwood, J.-A., & Doering, L. V. (2005). Gender differences in coronary artery disease. Journal of Cardiovascular Nursing, 20, 340–351.

    Google Scholar 

  • Fang, J., Foo, S. H., Fung, C., Wylie-Rosett, J., & Alderman, M. H. (2006). Stroke risk among Chinese immigrants in New York city. Journal of Immigrant Minority Health, 8, 387–393.

    Article  Google Scholar 

  • Fang, J., Foo, S. H., Jeng, J.-S., Yip, P.-K., & Alderman, M. H. (2004). Clinical characteristics of stroke among Chinese in New York City. Ethnicity & Disease, 14, 378–383.

    Google Scholar 

  • Flores, G. (2006). Language barriers to health care in the United States. The New England Journal of Medicine, 355, 229–231.

    Article  Google Scholar 

  • Fonarow, G. C., French, W. J., & Frederick, P. D. (2009). Trends in the use of lipid-lowering medications at discharge in patients with acute myocardial infarction: 1998 to 2006. American Heart Journal, 157, 185–194.

    Article  Google Scholar 

  • George, M. G., Tong, X., McGruder, H., Yoon, P., Rosamond, W., Winquist, A., et al. (2009). Paul Coverdell national acute stroke registry surveillance – four states, 2005–2007. Morbidity and Mortality Weekly Report: Surveillance Summaries, 58, 1–23.

    Google Scholar 

  • Ghosh, C. (2003). Healthy people 2010 and Asian Americans/Pacific Islanders: Defining a baseline of information. American Journal of Public Health, 93, 2093–2098.

    Article  Google Scholar 

  • Gonzalez-Fernandez, M., Kuhlemeier, K. V., & Palmer, J. B. (2008). Racial disparities in the development of dysphagia after stroke: Analysis of the California (MIRCal) and New York (SPARCS) inpatient databases. Archives of Physical Medicine and Rehabilitation, 89, 1358–1365.

    Article  Google Scholar 

  • Han, H.-R., Kim, K. B., Kang, J., Jeong, S., Kim, E.-Y., & Kim, M. T. (2007). Knowledge, beliefs, and behaviors about hypertension control among middle-aged Korean Americans with hypertension. Journal of Community Health, 32, 324–342.

    Article  Google Scholar 

  • Hemann, B. A., Bimson, W. F., & Taylor, A. J. (2007). The Framingham risk score: An appraisal of its benefits and limitations. The American Heart Hospital Journal, 5, 91–96.

    Article  Google Scholar 

  • Heron, M. (2010). Deaths: Leading causes for 2006. National Vital Statistics Reports, 58, 1–95.

    Google Scholar 

  • Higdon, J. V., & Frei, B. (2003). Tea catechins and polyphenols: Health effects, metabolism, and antioxidant functions. Critical Reviews in Food Science and Nutrition, 43, 89–143.

    Article  Google Scholar 

  • Hirsch, A. T., Criqui, M. H., Treat-Jacobson, D., Regensteiner, J. G., Creager, M. A., Olin, J. W., et al. (2001). Peripheral arterial disease detection, awareness, and treatment in primary care. Journal of the American Medical Association, 286, 1317–1324.

    Article  Google Scholar 

  • Holland, Ariel T., Wong, Eric C., Lauderdale, Diane S., & Palaniappan, Latha P. (2011). Spectrum of cardiovascular diseases in Asians-American racial/ethnic subgroups. Annals of Epidemiology, 21, 608–614.

    Article  Google Scholar 

  • Hwu, C. M., Hsiao, C.-F., Kuo, S.-W., Wu, K.-D., Ting, C.-T., Quertermous, T., et al. (2004). Physical inactivity is an important lifestyle determinant of insulin resistance in hypertensive patients. Blood Pressure, 13, 355–361.

    Article  Google Scholar 

  • Kagawa-Singer, M., & Kassim-Lakha, S. (2003). A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Academic Medicine, 78, 577–587.

    Article  Google Scholar 

  • Kandula, N. R., & Lauderdale, D. S. (2005). Leisure time, non-leisure time, and occupational physical activity in Asian Americans. Annals of Epidemiology, 15, 257–265.

    Article  Google Scholar 

  • Klatsky, A. L., Friedman, G. D., Sidney, S., Kipp, H., Kubo, A., & Armstrong, M. A. (2005). Risk of hemorrhagic stroke in Asian American ethnic groups. Neuroepidemiology, 25, 26–31.

    Article  Google Scholar 

  • Klatsky, A. L., & Tekawa, I. (2005). Health problems and hospitalizations among Asian-American ethnic groups. Ethnicity Disease, 15, 753–760.

    Google Scholar 

  • Kuzawa, C. W., & Sweet, E. (2009). Epigenetics and the embodiment of race: Developmental origins of US racial disparities in cardiovascular health. American Journal of Human Biology, 21, 2–15.

    Article  Google Scholar 

  • Lloyd-Jones, D., Adams, R. J., Brown, T. M., Carnethon, M., Dai, S., De Simone, G., et al. (2010). Heart disease and stroke statistics–2010 update: A report from the American Heart Association. Circulation, 121, e46–e215.

    Article  Google Scholar 

  • Lusis, A. J. (2000). Atherosclerosis. Nature, 407, 233–241.

    Article  Google Scholar 

  • Marmot, M. G., & Syme, S. L. (1976). Acculturation and coronary heart disease in Japanese-Americans. American Journal of Epidemiology, 104, 225–247.

    Google Scholar 

  • Marmot, M. G., Syme, S. L., Kagan, A., Kato, H., Cohen, J. B., & Belsky, J. (1975). Epidemiologic studies of coronary heart disease and stroke in Japanese men ­living in Japan, Hawaii and California: Prevalence of coronary and hypertensive heart disease and associated risk factors. American Journal of Epidemiology, 102, 514–525.

    Google Scholar 

  • Merchant, A. T., Kelemen, L. E., de Koning, L., Lonn, E., Vuksan, V., Jacobs, R., et al. (2008). Interrelation of saturated fat, trans fat, alcohol intake, and subclinical atherosclerosis. American Journal of Clinical Nutrition, 87, 168–174.

    Google Scholar 

  • Misra, A., & Khurana, L. (2009). The metabolic syndrome in south Asians: Epidemiology, determinants, and prevention. Metabolic Syndrome Related Disorders, 7, 497–514.

    Article  Google Scholar 

  • Narayan, K. M. V., Aviles-Santa, L., Oza-Frank, R., Pandey, M., Curb, J. D., McNeely, M., et al. (2010). Report of a National Heart, Lung, and Blood Institute Workshop: Heterogeneity in cardiometabolic risk in Asian Americans in the U.S. opportunities for research. Journal of the American College of Cardiology, 55, 966–973.

    Article  Google Scholar 

  • National Center for Health Statistics, Centers for Disease Control and Prevention. (2001). Report to evaluate the U.S. standard certificates.

    Google Scholar 

  • National Center for Health Statistics, Centers for Disease Control and Prevention. (2006). National Health and Nutrition Examination Survey: Screener module #1.

    Google Scholar 

  • National Center for Health Statistics, Centers for Disease Control and Prevention. (2007). National Health and Nutrition Examination Survey, 2007-2008: Let’s improve our health. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention.

    Google Scholar 

  • National Center for Health Statistics, Centers for Disease Control and Prevention. (2009a). 2008 NHIS questionnaire – sample adult adult identification.

    Google Scholar 

  • National Center for Health Statistics, Centers for Disease Control and Prevention. (2009b). Health, United States, 2008 with special feature on the health of young adults (Vol. DHHS publication No. 2009-1232). Hyattsville, MD: National Center for Health Statistics.

    Google Scholar 

  • National Center for Health Statistics, Centers for Disease Control and Prevention. (2010). National Health and Nutrition Examination Survey: Note on 2007-2008 sampling methodology. Retrieved February 15, 2010, from http://www.cdc.gov/nchs/nhanes/nhanes2007-2008/sampling_0708.htm.

  • Nguyen, T. T., Liao, Y., Gildengorin, G., Tsoh, J., Bui-Tong, N., & McPhee, S. J. (2009). Cardiovascular risk factors and knowledge of symptoms among Vietnamese Americans. Journal of General Internal Medicine, 24, 238–243.

    Article  Google Scholar 

  • Nguyen-Huynh, M. N., & Johnston, S. C. (2005). Regional variation in hospitalization for stroke among Asians/Pacific Islanders in the United States: A nationwide retrospective cohort study. BMC Neurology, 5, 21.

    Article  Google Scholar 

  • Office of Minority Health and Bureau of Primary Health Care, Health Resources and Services Administration. (2005). Reducing health disparities in Asian American & Pacific Islander populations: What is cultural ­competence. Retrieved February 8, 2011, from http://erc.msh.org/aapi/cc4.html.

  • Office of Minority Health, U.S. Department of Health and Human Services. (2010). Asian American/Pacific Islander profile. Retrieved February 8, 2011, from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=3&lvlid=29.

    Google Scholar 

  • Oza-Frank, R., Ali, M. K., Vaccarino, V., & Narayan, K. M. V. (2009). Asian Americans: Diabetes prevalence across U.S. and World Health Organization weight classifications. Diabetes Care, 32, 1644–1646.

    Article  Google Scholar 

  • Palaniappan, L. P., Araneta, M. R., Assimes, T. L., Barrett-Connor, E., Carnethon, M. R., Criqui, M. H., et al. (2010). Call to action: Cardiovascular disease in Asian Americans: A science advisory from the American Heart Association. Circulation, 122, 1242–1252.

    Article  Google Scholar 

  • Palaniappan, L. P., Mukherjea, A., Holland, A., & Ivey, S. L. (2010). Leading causes of mortality of Asian Indians in California. Ethnicity & Disease, 20, 53–57.

    Google Scholar 

  • Palaniappan, L., Wang, Y., & Fortmann, S. P. (2004). Coronary heart disease mortality for six ethnic groups in California, 1990-2000. Annals of Epidemiology, 14, 499–506.

    Article  Google Scholar 

  • Pleis, J. R., Lucas, J. W., & Ward, B. W. (2009). Summary health statistics for U.S. adults: National Health Interview Survey, 2008. Vital Health Statistics, 10, 1–157.

    Google Scholar 

  • Popkin, B. M., Horton, S., Kim, S., Mahal, A., & Shuigao, J. (2001). Trends in diet, nutritional status, and diet-related noncommunicable diseases in China and India: The economic costs of the nutrition transition. Nutrition Reviews, 59, 379–390.

    Article  Google Scholar 

  • Ren, J., & Kelley, R. O. (2009). Cardiac health in women with metabolic syndrome: Clinical aspects and pathophysiology. Obesity, 17, 1114–1123.

    Google Scholar 

  • Rodriguez, B. L., D’Agostino, R., Abbott, R. D., Kagan, A., Burchfiel, C. M., Yano, K., et al. (2002). Risk of hospitalized stroke in men enrolled in the Honolulu Heart Program and the Framingham study: A comparison of incidence and risk factor effects. Stroke, 33, 230–236.

    Article  Google Scholar 

  • Schwartz, S. J., Unger, J. B., Zamboanga, B. L., & Szapocznik, J. (2010). Rethinking the concept of acculturation: Implications for theory and research. American Psychologist, 65, 237–251.

    Article  Google Scholar 

  • Sechena, R., Liao, S., Lorenzana, R., Nakano, C., Polissar, N., & Fenske, R. (2003). Asian American and Pacific Islander seafood consumption – a community-based study in King county, Washington. Journal of Exposure Analysis and Environmental Epidemiology, 13, 256–266.

    Article  Google Scholar 

  • Song, Y. J., Hofstetter, C. R., Hovell, M. F., Paik, H. Y., Park, H. R., Lee, J., et al. (2004). Acculturation and health risk behaviors among Californians of Korean descent. Preventive Medicine, 39, 147–156.

    Article  Google Scholar 

  • Spatz, E. S., Ross, J. S., Desai, M. M., Canavan, M. E., & Krumholz, H. M. (2010). Beyond insurance coverage: Usual source of care in the treatment of hypertension and hypercholesterolemia. Data from the 2003-2006 National Health and Nutrition Examination Survey. American Heart Journal, 160, 115–121.

    Article  Google Scholar 

  • Tang, H., Shimizu, R., & Chen, M. S., Jr. (2005). English language proficiency and smoking prevalence among California’s Asian Americans. Cancer, 104, 2982–2988.

    Article  Google Scholar 

  • Taylor, V. M., Yasui, Y., Tu, S.-P., Neuhouser, M. L., Li, L., Woodall, E., et al. (2007). Heart disease prevention among Chinese immigrants. Journal of Community Health, 32, 299–310.

    Article  Google Scholar 

  • Taylor-Piliae, R. E., Haskell, W. L., & Froelicher, E. S. (2006). Hemodynamic responses to a community-based Tai Chi exercise intervention in ethnic Chinese adults with cardiovascular disease risk factors. European Journal of Cardiovascular Nursing, 5, 165–174.

    Article  Google Scholar 

  • The Kaiser Family Foundation. (2008). Health coverage and access to care among Asian Americans, Native Hawaiians, and Pacific Islanders. Race, Ethnicity, & Health Care Fact Sheet. Menlo Park, CA: Kaiser Family Foundation.

    Google Scholar 

  • Ton, T. G., Steinman, L., Yip, M.-P., Ly, K. A., Sin, M.-K., Fitzpatrick, A. L., et al. (2010). Knowledge of cardiovascular health among Chinese, Korean and Vietnamese immigrants to the US. Journal of Immigrant Minority Health, 13(1), 127–139.

    Article  Google Scholar 

  • U.S. White House Office of the Press Secretary. (2009, October 14). Executive Order: Increasing Participation of Asian Americans. Retrieved from http://www.whitehouse.gov/the-press-office/executive-order-asian-american-and-pacific-islander-community.

  • U.S. Census Bureau. (2001). Introduction to Census 2000 Data Products.

    Google Scholar 

  • U.S. Census Bureau. (2008). B02006. Asian alone by selected groups. American Community Survey, 2006-2008.

    Google Scholar 

  • U.S. Census Bureau. (2010). What is the census? Retrieved December 12, 2010, from http://2010.census.gov/2010census/about/.

  • Ueshima, H., Sekikawa, A., Miura, K., Turin, T. C., Takashima, N., Kita, Y., et al. (2008). Cardiovascular disease and risk factors in Asia: A selected review. Circulation, 118, 2702–2709.

    Article  Google Scholar 

  • Wild, S. H., Laws, A., Fortmann, S. P., Varady, A. N., & Byrne, C. D. (1995). Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985 to 1990. Annals of Epidemiology, 5, 432–439.

    Article  Google Scholar 

  • Yagalla, M. V., Hoerr, S. L., Song, W. O., Enas, E., & Garg, A. (1996). Relationship of diet, abdominal obesity, and physical activity to plasma lipoprotein levels in Asian Indian physicians residing in the United States. Journal of the American Dietetic Association, 96, 257–261.

    Article  Google Scholar 

  • Ye, J., Rust, G., Baltrus, P., & Daniels, E. (2009). Cardiovascular risk factors among Asian Americans: Results from a National Health Survey. Annals of Epidemiology, 19, 718–723.

    Article  Google Scholar 

  • Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F., et al. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet, 364, 937–952.

    Article  Google Scholar 

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Holland, A.T., Palaniappan, L.P. (2013). Heterogeneity in Cardiovascular Health among Asian American Subgroups: Risk Factors, Outcomes, Treatment and Prevention, and Future Research Opportunities. In: Yoo, G., Le, MN., Oda, A. (eds) Handbook of Asian American Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2227-3_16

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