Risk for Stroke, CHD Differ by Multiracial and Multiethnic Asian Subgroup

Risk for stroke and coronary heart disease (CHD) is higher among Asian, Hawaiian, and Pacific Islander multiracial or multiethnic subgroups, according to results of a study published in the Journal of the American Heart Association.

The dynamics of cardiovascular disease (CVD) are poorly understood among Asian subgroups, in part because these groups are typically aggregated in research studies.

Investigators from Kaiser Permanente sourced data for this study from the Cardiovascular Disease Among Asians and Pacific Islanders (CASPER) study, which recruited adults (N=303,958) between 2011 and 2018 from 2 large health care systems in Hawaii and California in the United States. Incident stroke and CHD were evaluated on the basis of racial and ethnic subgroup. The adjusted analyses accounted for age, income, education, BMI, smoking status, and comorbidities.

The study population comprised White (56.9%); Asian Indian (10.6%); Chinese (10.4%); Filipino (7.9%); Japanese (5.2%); Pacific Islander and Asian (1.9%); Asian and White (1.8%); Pacific Islander, Asian, and White (1.5%); Korean (1.3%); Pacific Islander and White (1.2%); other Pacific Islander (0.9%); and Native Hawaiian (0.4%) individuals.

During a median follow-up of 3.5 years, risk for CHD was decreased among Hawaiian (adjusted hazard ratio [aHR], 0.55), Korean (aHR, 0.57), Japanese (aHR, 0.66), and Chinese (aHR, 0.69) women and among Hawaiian (aHR, 0.49), Korean (aHR, 0.50), Japanese (aHR, 0.65), Chinese (aHR, 0.70), and Filipino (aHR, 0.89) men relative to White women and men. Risk for CHD was higher among Pacific Islander and White (aHR, 1.28) and Pacific Islander, Asian, and White (aHR, 1.26) women and among Pacific Islander and Asian (aHR, 1.36); Pacific Islander, Asian, and White (aHR, 1.32); and Asian Indian (aHR, 1.16) men compared with White women and men.

For stroke, Asian Indian (aHR range, 0.60-0.77) and Japanese (aHR range, 0.81-0.85) women and men were at lower risk and Hawaiian (aHR, 1.53); Pacific Islander and White (aHR, 1.48); Pacific Islander and Asian (aHR, 1.44); and Pacific Islander, Asian, and White (aHR, 1.35) women and Asian and White (aHR, 1.56) and Pacific Islander and White (aHR, 1.56) men were at higher risk relative to White women and men.

This study was limited by not including complete data about lifestyle factors, such as physical activity and diet.

The study authors concluded, “Multiracial and multiethnic AANHPI [American Asian, Native Hawaiian, and Pacific Islander] individuals and single-ethnicity Pacific Islander individuals had higher risks of CHD and stroke than NHW [non-Hispanic White] individuals; these differences were partially explained by modifiable factors. Future studies should further explore lifestyle and acculturation factors that may contribute to differences in CHD and stroke risk among AANHPI subgroups, with a particular focus on the risks for multiracial and multiethnic AANHPI populations.”

This article originally appeared on The Cardiology Advisor