Challenging Aspects to Precise Health Strategies in Native Hawaiian and Other Pacific Islanders Using Statins

Abstract

Cardiometabolic disorders (CD), including cardiovascular disease (CVD), diabetes, and obesity, are the leading cause of health concern in the United States (U.S.), disproportionately affecting indigenous populations such a Native Hawaiian and Other Pacific Islanders (NHOPI). Dyslipidemia, a prevalent risk factor for the development and progression of CVD, is more prone to occur in NHOPI than other populations in the U.S. High-intensity statin therapy to reduce low-density lipoprotein cholesterol is associated with the prevention of CVD events. However, significant side-effects, such as muscle disorders, have been associated with its use. Different ethnic groups could experience variation in the prevalence of statin side effects due to sociodemographic, behavioral, and/or biological factors. Therefore, identifying the most impactful determinants that can be modified to prevent or reduce statin side effects for individuals from high-risk ethnic minority groups, such as NHOPI, can lead to more effective strategies to reduce health disparities. Thus, our Mini-Review explores the challenging aspects of public health precise strategies in NHOPI taking statins, including a culturally informed additional therapy that could positively impact the NHOPI population.

The Molecular-Social-Genetic Determinants of Cardiovascular Health in Pacific Islanders

“…Historically, NHOPI individuals have received relatively less attention in cardiovascular health research. 1 In addition, within the NHOPI racial category, ethnic groups such as Hawaiian, Samoan, Tahitian, and Māori individuals are seldom delineated and thereby understudied. To explore this unmet need further, we systematically reviewed existing human health data sets and large-scale epidemiological cohort studies across different biological databases and biobanks covering various cardiovascular disease phenotypes to assess current NHOPI representation therein ( Table 1 ).…”

“…As a result of multiple risk factors, NHOPI individuals are disproportionately burdened by cardiometabolic diseases. 1 , 3 Recent studies have shown that NHOPI patients have high rates of undiagnosed T2D as well as high rates of diagnosed metabolic disease: 19% to 22% for T2D, and 16% to 35% for impaired glucose tolerance. 1 , 2 One recent prospective study found a prevalence of T2D as high as 57.9%, noting that many cases were previously undiagnosed.…”

“…The term “Pacific Islander” typically refers to people with roots in the indigenous communities of Polynesia, Micronesia, and Melanesia, and “Native Hawaiian” specifically refers to individuals who descend from indigenous peoples who lived in the Hawaiian Archipelago before Western contact. 1 , 2 As a result of their smaller population size relative to other racial and ethnic groups within the United States, and frequent aggregation with other demographics, Native Hawaiian and Other Pacific Islander (NHOPI) individuals have historically been left underrepresented in biomedical research datasets. 2 Significant health disparities exist among NHOPI individuals relative to other populations, including higher rates of obesity, type 2 diabetes (T2D), and cardiovascular disease (CVD), in addition to their associated risk factors.…”

“…2 Significant health disparities exist among NHOPI individuals relative to other populations, including higher rates of obesity, type 2 diabetes (T2D), and cardiovascular disease (CVD), in addition to their associated risk factors. 1 , 3 NHOPI individuals also represent one of the fastest-growing populations in the United States and this rapid growth could intensify existing disparities unless the underlying causes are identified and effectively addressed. 1 Consequently, there is a critical need for enhanced research, more innovative drug discovery, and targeted clinical interventions tailored to these underrepresented populations.…”

“… 1 , 3 NHOPI individuals also represent one of the fastest-growing populations in the United States and this rapid growth could intensify existing disparities unless the underlying causes are identified and effectively addressed. 1 Consequently, there is a critical need for enhanced research, more innovative drug discovery, and targeted clinical interventions tailored to these underrepresented populations.…”