Metabolic syndrome and the burden of cardiovascular disease in Caribbean Hispanic women living in northern Manhattan: a red flag for education

Cardiovascular disease risk in Hispanic American women

Hispanic American women have an increased risk for the development of cardiovascular disease (CVD). This study examined CVD risk in a sample of immigrant Hispanic women using Framingham point scores and the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator for 10-year CVD risk and prevalence of metabolic syndrome. A cross-sectional study using baseline data from a diabetes self-management intervention study in a sample of 118 Hispanic American women was conducted. Data were c ollected with interviewer-administered surveys, and HbA1C and lipid profiles were obtained through capillary finger stick blood at clinics and churches in rural counties in central North Carolina. A majority (58%) of the women had type 2 diabetes and 61% had metabolic syndrome. Using the Framingham point scores for 10-year CVD risk, 2.5% were determined to have intermediate risk, compared to 7.6% at intermediate risk and 2.5% at high risk using the ASCVD 10-year risk estimator. High rates of CVD risk factors were found among this sample of Hispanic women. Early recognition of risk, mitigation of modifiable risk factors, and effective self-care programs are needed for Hispanic women. Hispanic American women may benefit from community-based CVD educational programs that have been culturally and linguistically tailored.

Characterization of metabolic syndrome among diverse Hispanics/Latinos living in the United States: Latent class analysis from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BACKGROUND/OBJECTIVES

Empirical investigation of the adequacy of metabolic syndrome (MetS) diagnostic criteria, and whether meaningful subtypes of MetS exist, is needed among Hispanics/Latinos.

METHODS

In 15,825 US Hispanics/Latinos from HCHS/SOL, latent class analysis of MetS components (waist circumference, systolic and diastolic blood pressure, HDL cholesterol, triglycerides, glucose, and antihypertensive, lipid- and glucose-lowering medication use) was used to investigate (1) whether distinct subtypes of MetS could be identified, and how component levels differed between them, and (2) how identified subtypes related to covariates and cardiovascular disease (CVD) prevalence.

RESULTS

Two latent clusters emerged in both men (n=6317) and women (n=9508): one characterized by relatively healthy mean levels (Non-MetS cluster, 77.1% of men and 67.1% of women) and the other by clinically elevated mean levels (MetS cluster, 22.9% of men and 32.9% of women) across most MetS components. These clusters showed expected associations with covariates and CVD prevalence. Notable results suggest that (1) HDL cholesterol may poorly differentiate between US Hispanics/Latinos with and without MetS (mean=45.4 vs. 44.6 mg/dL for men and 51.3 vs. 52.0 mg/dL for women in the MetS vs. Non-MetS clusters, respectively) and (2) the NCEP-ATP III 88 cm waist circumference cutoff for US females may not optimize diagnosis among Hispanic/Latino women (MetS cluster mean waist circumference=102.5 cm).

CONCLUSIONS

Beyond classification into having MetS or not, additional subtypes of MetS do not clearly emerge in US Hispanics/Latinos. Current diagnostic cutoffs for some components may not optimize MetS identification among this population.

Effect of ethnicity on liver transplant for hepatocellular carcinoma

OBJECTIVES

The incidence of hepatocellular carcinoma associated with nonalcoholic fatty liver disease is increasing. We sought to compare tumor characteristics and outcomes after a liver transplant according to the cause of liver disease and ethnicity.

MATERIALS AND METHODS

We retrospectively evaluated patients with hepatocellular carcinoma (292, 23%) out of all the liver transplant recipients (N=1266) at the University of Miami between 2000 and 2010. Liver disease was caused by hepatitis C virus in 221 patients (76%), nonalcoholic fatty liver disease in 19 patients (6.5%), hepatitis B virus in 20 patients (7%), alcohol in 44 patients (15%), and other in 18 patients (6%). The median age was 57 years (range, 17 to 77 y), 218 were men (75%), 270 were white (92%), and 92 were Hispanic (31.5%).

RESULTS

Patients with hepatocellular carcinoma and nonalcoholic fatty liver disease were more likely to be older (64 vs 57; P = .0006), Hispanic (58% vs 30%; P = .018); nonsmokers (89% vs 65%; P = .041), diabetic (84% vs 26% P < .0001), hypertensive (63% vs 27%; P = .003), and using statins (32% vs 4%; P = .0004) compared with hepatocellular carcinoma without nonalcoholic fatty liver disease. Diabetes, hypertension, and nonalcoholic fatty liver disease are significantly more common in Hispanics than in non-Hispanic persons with hepatocellular carcinoma. In persons without hepatocellular carcinoma, the proportion of Hispanics was similar between those with (n=84) and those without (n=1182) nonalcoholic fatty liver disease. Hispanic ethnicity was not associated with worse tumor behavior or overall survival.

CONCLUSIONS

Patients transplanted for hepatocellular carcinoma and nonalcoholic fatty liver disease were older, and were more frequently Hispanic than were persons with hepatocellular carcinoma and without [corrected] nonalcoholic fatty liver disease. Hispanic ethnicity may be a risk factor for hepatocellular carcinoma.

Factors related to weight loss attempt among Dominican immigrants

To assess weight loss attempt among a Latino immigrant population from the Dominican Republic we analyzed data on 585 overweight and obese Dominicans from a cross-sectional survey using Chi-square statistics, Student's t-tests, and logistic regression models. We found 58% of the overweight and obese tried to lose weight. Female gender (OR 2.28, CI 1.53-3.39), overweight perception (OR 2.37, CI 1.57-3.60) and weight loss advice from health professionals (OR 1.90, CI 1.24-2.91) were strongly associated with weight loss attempt. Individuals with diabetes were more likely to receive advice to lose weight (OR 2.58, CI 1.18-5.63; yet, they were more satisfied with their weight (40.5 vs. 27.8%, p < 0.021), and no difference in their weight loss attempt (p = 0.849) was detected compared to individuals without diabetes. We conclude a significant proportion of overweight and obese Dominican immigrants do not attempt to lose weight. Overweight perception and, except among individuals with diabetes, weight loss advice were strong inducements to weight loss attempt.

Exploring risk factors in Latino cardiovascular disease: the role of education, nativity, and gender

OBJECTIVES

We examined 3 cardiovascular disease risk factors by nativity and gender, evaluating evidence for education and health behaviors in explaining the "Hispanic Health Paradox."

METHODS

We analyzed 2001-2008 National Health and Nutrition Examination Survey data for adults (n = 6032) to compare hypertension, high waist circumference, and diabetes for US- and foreign-born Mexican men and women. We controlled for age, depression, and health insurance.

RESULTS

Cardiovascular disease risk factors differed by education, nativity, and gender. Higher education was associated with higher odds of hypertension and high waist circumference for men and women regardless of nativity. As education increased, the odds of diabetes increased for US-born women, showing a gradient for this population. Finally, foreign-born Mexican women with 5 to 19 years in the United States conferred the highest odds of having diabetes, whereas foreign-born men with less than 5 years in the United States had the lowest odds for high waist circumference and presence of diabetes.

CONCLUSIONS

Results contest assumptions of the Hispanic Health Paradox and suggest new approaches. New research can yield accurate information to ensure the development of appropriate interventions, decreasing health disparities endemic to a subgroup of Latinos.

The DHHS Office on Women's Health Initiative to Improve Women's Heart Health: focus on knowledge and awareness among women with cardiometabolic risk factors

Abstract Background: The diversity of the U.S. population and disparities in the burden of cardiovascular disease (CVD) require that public health education strategies must target women and racial/ethnic minority groups to reduce their CVD risk factors, particularly in high-risk communities, such as women with the metabolic syndrome (MS).

METHODS

The data reported here were based on a cross-sectional face-to-face survey of women recruited from four participating sites as part of the national intervention program, Improving, Enhancing and Evaluating Outcomes of Comprehensive Heart Care in High-Risk Women. Measures included baseline characteristics, sociodemographics, CVD related-knowledge and awareness, and Framingham risk score (FRS).

RESULTS

There were 443 of 698 women (63.5%) with one or more risk factors for the MS: non-Hispanic white (NHW), 51.5%; non-Hispanic black (NHB), 21.0%; Hispanic, 22.6%. Greater frequencies of MS occurred among Hispanic women (p<0.0001), those with less than a high school education (70.0%) (p<0.0001), Medicaid recipients (57.8%) (p<0.0001), and urbanites (43.3%) (p<0.001). Fewer participants with MS (62.6%) knew the leading cause of death compared to those without MS (72.1%) (p<0.0001). MS was associated with a lack of knowledge of the composite of knowing the symptoms of a heart attack plus the need to call 911 (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.17-0.97, p=0.04).

CONCLUSIONS

Current strategies to decrease CVD risk are built on educating the public about traditional factors, including hypertension, smoking, and elevated low-density lipoprotein cholesterol (LDL-C). An opportunity to broaden the scope for risk reduction among women with cardiometabolic risk derives from the observation that women with the MS have lower knowledge about CVD as the leading cause of death, the symptoms of a heart attack, and the ideal option for managing a CVD emergency.