Big differences found in heart and stroke risks among Asian American, Native Hawaiian and Pacific Islander groups

The frequency of traditional cardiovascular risk factors, such as high blood pressure and high cholesterol, and the overall risk of having a heart attack or stroke varies greatly among Asian American, Native Hawaiian and Pacific Islander populations, even though these groups are usually grouped together for research purposes, new research shows.

The findings were presented last week at the American Heart Association's Epidemiology and Prevention/Lifestyle and Cardiometabolic Health Scientific Sessions in New Orleans. They are considered preliminary until full results are published in a peer-reviewed journal.

The practice of aggregating data for these distinct groups "masks important variations in both risk factor prevalence and disease burden," lead study author Rishi V. Parikh said in a news release. Parikh is a senior research analyst at the Kaiser Permanente Northern California Division of Research in Pleasanton.

"Despite being the fastest-growing population in the U.S., existing studies about Asian subgroups remain limited by inadequate sample size and exclusion of some major disaggregated subgroups, as well as a lack of long-term follow-up," he said.

Prior research has noted differences among AANHPI subgroups, including a higher death rate from cardiovascular disease in Native Hawaiian and Pacific Islander adults compared to non-Hispanic white adults in the U.S.

In the new study – the Pacific Islander, Native Hawaiian and Asian American Cardiovascular Health Epidemiology, or PANACHE – researchers analyzed health records from 2012 to 2022 for more than 2.6 million adults in large, private health systems in California and Hawaii who were an average of 49 years old with no history of heart attack, stroke, heart failure or atrial fibrillation. About 677,500 participants self-identified as Chinese, Filipino, Native Hawaiian or other Pacific Islander, Japanese, Korean, Vietnamese, other Southeast Asian (including Thai, Laotian, Cambodian, Hmong, Burmese, Indonesian, Malaysian or Singaporean) or South Asian (including Indian, Pakistani, Sri Lankan, Bangladeshi, Nepali or Bhutanese).

Researchers compared the prevalence of traditional cardiovascular risk factors, including high blood pressure, high cholesterol, obesity, Type 2 diabetes, chronic kidney disease and smoking, among adults belonging to a single AANHPI subgroup to nearly 2 million non-Hispanic white adults in the same health system database. They also used the AHA's PREVENT risk calculator to predict the participants' 10-year risk for a cardiovascular event.

Compared to non-Hispanic white adults, all AANHPI subgroups had higher rates of diabetes and high cholesterol, and all but Native Hawaiian/Pacific Islander adults had lower rates of smoking. But there were significant variations among subgroups in the prevalence of cardiovascular disease risk factors.

High blood pressure ranged from 12% of Chinese adults to a high of 30% among Filipino adults. Chinese and Filipino adults also had the lowest (20%) and highest (33%) rates of high cholesterol, respectively. Chinese adults also had the lowest rate of Type 2 diabetes, at just 5%, compared to 14% for Native Hawaiian/Pacific Islander adults.

There was a wider disparity in obesity rates, which ranged from 11% in Vietnamese adults to 41% in Native Hawaiian/Pacific Islander adults, who also had the highest risk among subgroups for experiencing a heart attack or stroke within 10 years.

"At the individual patient level, our findings along with previous work suggest that regular monitoring of risk factors like blood pressure and cholesterol may be helpful for early detection of increased risk and prevention of cardiovascular disease among Asian American, Native Hawaiian and Pacific Islander populations," study co-author Dr. Alan S. Go said in the news release. Go is an associate director of the Kaiser Permanente Northern California Division of Research, Cardiovascular and Metabolic Conditions Research.

Go said a next step for the PANACHE study would be a population-based survey to describe risk factors not routinely available in an electronic health record. These could include immigration history, generational status, employment history, experiences of discrimination, acculturation, diet, physical activity, and access to health care services and other resources that may be unique to each subgroup.

The additional data, Go said, "will help us understand sources of health disparities and inform tailored cardiovascular prevention strategies for AANHPI individuals, both in the clinic and in the community."

Dr. Sadiya S. Khan said in the news release that because cardiovascular disease remains the leading cause of death for all Americans, "understanding differences among specific population groups can identify gaps in monitoring and management of risk factors, such as obesity, hypertension and Type 2 diabetes."

Khan led the writing group for the AHA's scientific statement on the PREVENT risk calculator in 2023 but was not involved in the new research. She is a preventive cardiologist at Northwestern Medicine in Chicago.

"These findings further underscore that Asian Americans represent a diverse and heterogeneous group, and research should prioritize inclusion and appropriate identification of Asian Americans and various subgroups to improve cardiovascular health for all," Khan said.