- Coronary artery disease (CAD) is the dominant form of cardiovascular disease (CVD) in the Western countries, with Europeans and Americans having a 3-4-fold higher rate of death from CAD than from stroke. In sharp contrast, stroke is the major form of CVD in the East, with Asians having a 3-4-fold higher rate of death from stroke than from CAD.1
- Stroke death rates in Japan and Taiwan remain the highest in the world. The high frequency of stroke in Asians is largely attributed to uncontrolled hypertension from high dietary salt intake, whereas the high rates of CAD in Americans and Europeans is due to elevated levels of blood cholesterol from high intake of saturated fat.3
- Dyslipidemia appears to be the major risk factor for heart disease, whereas hypertension is the principal risk factor for stroke.
- Accordingly control of CVD among Asians should focus on the control of blood pressure whereas control of cholesterol is more crucial for Americans and Europeans as well as Asian Indians.
- The CVD rates among immigrants are generally intermediate between that of the country of origin and the dominant culture of the adopted land. The degree and the speed of acculturation, as well as the prevailing CVD rates in the country of origin and the country of adoption determine the new rates among the immigrants.2
- Asians respond differently to many life saving medications for example, heparin. Asians require 10 IU/kg less heparin per weight than other racial groups to achieve the same goal of anticoagulation. Accordingly, decreased heparin dosing should be considered for Asian patients undergoing coronary angioplasty or stent.3
- Asian Americans and Pacific Islanders are a fast-growing subpopulation in the U.S. Asian Americans in the country grew 46% (6 times faster than the general US Population) in the 1990s.4 This group consists of mostly immigrant Japanese, Chinese, Koreans, Filipinos, Vietnamese and Asian Indians. Considerable geographical, ethnic, cultural, linguistic, and genetic diversity exists within the Asian-American population in the US with 60 different ethnicities that speak 100 different languages and dialects. Asian Americans represent 25% of all foreign-born people in the US, with 88% of Asian Americans being either foreign-born or having at least one foreign-born parent.4
- More than 75% of Japanese, Filipino, and Asian Indian adults have higher average incomes (200% of the poverty threshold or greater).4 Asian Indians but not other Asian Americans have proportionally higher cardiovascular mortality rates when compared with Caucasians, despite higher levels of education and income.5
- The group brings the challenges of enormous genetic and cultural diversity with striking differences in the risk of cardiovascular disease (CVD), obesity, diabetes and other CVD risk factors. For example, Asian Indians, Japanese, and Filipinos have high rates of diabetes without correspondingly high rates of obesity.4
- Elevated risk of diabetes, hypertension, high LDL, and low HDL seem to be the most common traditional CVD risk factors among all Asian Americans, but appear at younger ages in South Asians.4
- Upon immigration, the Asian Americans experience an increase in the CAD rates commensurate with their increased dietary intake of saturated fat, resulting in elevated serum levels of cholesterol. However, the CAD rates among these Asian Americans are about half that of Whites.1, 6, 7 The mortality rates among Asian Americans and other Americans are given in Figure 008.8 Asian Indians are an important exception in having higher rates of CAD than the dominant culture in the US and elsewhere. See Asian Indian heart disease.
- This increase in the CAD rate among Asian Americans, however, is accompanied by a marked decrease in stroke rate, which was nearly identical to whites for many years. The current data shows that the stroke rates among Asian Americans as a group is only half that of whites possibly due to greater recognition, treatment, and control of blood pressure.8
- Given the heterogeneity in body weight, body size, and CVD risk, these populations afford a unique model to study the interaction and relationships between visceral adiposity and adipose tissue distribution and beta-cell function, insulin resistance, and atherosclerosis. 4
- These differences highlight the importance of conducting research among Asian subgroups separately as well as together. Asian-American populations, given the diversity and high proportion of immigrants, also offer opportunities to disentangle the roles of biology, socioeconomic factors, and acculturation stresses in CVD etiology. 4
- Lessons learned from studies of Asian American groups may answer questions regarding cardiometabolic risk that will be of value not just to the health of this growing and diverse subpopulation in the U.S., but also to the general population of the country.4, 9
Q. Who are Pacific Islanders?
A. Paciﬁc Islanders in the US are people from Hawaii, Guam, and Samoa. They are ethnically different but usually grouped together with Asian Americans in the US national statistics. They have high rates of diabetes, and CVD and highest rates of obesity.10 Prevalence of obesity is 53% for men and 75% for women and overweight is 95% for men and 100% for women.10
1. Jha P, Enas E, Yusuf S. Coronary Artery Disease in Asian Indians: Prevalence and Risk Factors. Asian Am Pac Isl J Health. Autumn 1993;1(2):163-175.
2. Benfante R. 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. Hum Biol. 1992;64(6):791-805.
3. Shimada YJ, Nakra NC, Fox JT, Kanei Y. Relation of race (Asian, African-American, European-American, and Hispanic) to activated clotting time after weight-adjusted bolus of heparin during percutaneous coronary intervention. Am J Cardiol. Mar 1 2010;105(5):629-632.
4. Narayan K M, Aviles-Santa L, Oza-Frank R, et al. Report of a National Heart, Lung, And Blood Institute Workshop: heterogeneity in cardiometabolic risk in Asian Americans In the U.S. Opportunities for research. J Am Coll Cardiol. Mar 9 2010;55(10):966-973.
5. Palaniappan L, Wang Y, Fortmann SP. Coronary heart disease mortality for six ethnic groups in California, 1990-2000. Ann Epidemiol. Aug 2004;14(7):499-506.
6. Benfante R, Hwang LJ, Masaki K, Curb JD. To what extent do cardiovascular risk factor values measured in elderly men represent their midlife values measured 25 years earlier? A preliminary report and commentary from the Honolulu Heart Program. Am J Epidemiol. 1994;140(3):206-216.
7. Klatsky AL, Tekawa I, Armstrong MA, Sidney S. The risk of hospitalization for ischemic heart disease among Asian Americans in northern California. Am J Public Health. Oct 1994;84(10):1672-1675.
8. Xu J, Kochanek K D, Murphy S L. Deaths: Final Data for 2007.National Vital Statistics Statistics Report. Vol 58,. CDC, Atlanta 2010.
9. Cornier MA, Despres JP, Davis N, et al. Assessing adiposity: a scientific statement from the american heart association. Circulation. Nov 1 2011;124(18):1996-2019.
10. Sundborn G, Metcalf PA, Gentles D, et al. Overweight and obesity prevalence among adult Pacific peoples and Europeans in the Diabetes Heart and Health Study (DHAHS) 2002-2003, Auckland New Zealand. N Z Med J. Mar 19 2010;123(1311):30-42.