Cardiovascular and Cerebrovascular Disease Mortality in Asian American Subgroups

Abstract

Background: Asian American individuals comprise the fastest-growing race and ethnic group in the United States. Certain subgroups may be at disproportionately high cardiovascular risk. This analysis aimed to identify cardiovascular and cerebrovascular disease mortality trends in Asian American subgroups. Methods: Age-standardized mortality rates (ASMR), average annual percent change of ASMR calculated by regression, and proportional mortality ratios of ischemic heart disease, heart failure, and cerebrovascular disease were calculated by sex in non-Hispanic Asian American subgroups (Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese), non-Hispanic White, and Hispanic individuals from US death certificates, 2003 to 2017. Results: Among 618 004 non-Hispanic Asian American, 30 267 178 non-Hispanic White, and 2 292 257 Hispanic deaths from all causes, ASMR from ischemic heart disease significantly decreased in all subgroups of Asian American women and in non-Hispanic White and Hispanic women; significantly decreased in Chinese, Filipino, Japanese, and Korean men and non-Hispanic White and Hispanic men and remained stagnant in Asian Indian and Vietnamese men. The highest 2017 ASMR from ischemic heart disease among Asian American decedents was in Asian Indian women (77 per 100 000) and men (133 per 100 000). Heart failure ASMR remained stagnant in Chinese, Korean, and non-Hispanic White women, and Chinese and Vietnamese men. Heart failure ASMR significantly increased in both sexes in Filipino, Asian Indian, and Japanese individuals, Vietnamese women, and Korean men, with highest 2017 ASMR among Asian American subgroups in Asian Indian women (14 per 100 000) and Asian Indian men (15 per 100 000). Cerebrovascular disease ASMR decreased in Chinese, Filipino, and Japanese women and men between 2003 and 2017, and remained stagnant in Asian Indian, Korean, and Vietnamese women and men. The highest cerebrovascular disease ASMR among Asian American subgroups in 2017 was in Vietnamese women (46 per 100 000) and men (47 per 100 000). Conclusions: There was heterogeneity in cardiovascular and cerebrovascular mortality among Asian American subgroups, with stagnant or increasing mortality trends in several subgroups between 2003 and 2017.

Association of Acculturation with Cardiovascular Risk Factors in Asian-American Subgroups

“…This analysis demonstrates the need to better characterize the differential health risks among Asian subgroups to inform culturally specific health interventions. These observations are consistent with recently published work showing differences in CV mortality among Asian-American subgroups: Asian Indians had the highest risk of CV due to ischemic heart disease and heart failure, while the highest cerebrovascular disease mortality rate occurred among Vietnamese individuals [8] .…”

“…Another NHANES study found higher acculturation level was associated with greater intake of ultra- processed foods among Asian-Americans [7] . The major Asian-American subgroups in the US include Asian Indian, Chinese, Filipino, Japanese, Koreans, and Vietnamese who have heterogeneous CV mortality rates, with the highest rates due to ischemic heart disease and heart failure occurring among Asian Indian men and women [8] . Publicly available, disaggregated Asian subgroup identification in nationally representative data from NHANES and NHIS are limited, thus presenting challenges to understand the association between acculturation level and CV risk factors among the subgroups.…”

Racial and Ethnic Disparities in Hypertension: Barriers and Opportunities to Improve Blood Pressure Control

“…However, these results were pooled individuals of multiple Asian ethnicities, and the lack of disaggregation of Asian subgroups for risk assessment remains a significant clinical issue. There are major differences in ASCVD risk with South Asian people at substantially higher risk while most East Asian people, including Chinese-Americans, Japanese-Americans, and Korean-Americans at much lower risk [ 64 , 65 ]. Similar to Asian subgroups, those of Hispanic or Latinx origin also experience heterogeneity in ASCVD risk, with people of Puerto Rican or Caribbean descent carrying a higher risk than those of Mexican descent [ 61 ].…”

Cardiovascular risk-enhancing factors and coronary artery calcium in South Asian American adults: The MASALA study

“…These REFs include family history of premature ASCVD, chronic kidney disease (CKD), ankle-branchial index (ABI) <0.9, triglycerides ≥175 mg/dL, low-density lipoprotein cholesterol (LDL-C) 160–190 mg/dL, metabolic syndrome (MetS), chronic inflammatory diseases, high-sensitivity C-reactive protein (hsCRP) ≥2 mg/dL, lipoprotein(a) (Lp(a)) ≥50 mg/dL, apolipoprotein B ≥ 130 mg/dL, and for women, premature menopause and pregnancy-associated conditions (e.g., preeclampsia) that increase ASCVD risk [ 1 , 2 ]. Additionally, South Asian ethnicity was identified as a REF due to the disproportionately elevated risk for premature ASCVD in this population compared with other Asian American subgroups and non-Hispanic White individuals [ 1 , [3] , [4] , [5] ].…”