Here’s the good news: The number of deaths among Hispanics due to cardiovascular disease is down, according to national mortality statistics.
But here’s the catch: Strokes and diseases of the heart are still the No. 1 killer of Hispanics and account for more deaths than all forms of cancer combined.
Hispanics pose a dilemma for physicians and researchers. While they face higher risks of developing problems because of higher incidences of obesity, diabetes and high blood pressure, they’re less likely to die as a result of these issues.
“It’s referred to as the Hispanic Paradox,” said Dr. Gervasio Lamas, Mount Sinai Medical Center’s chief of cardiology. “In general, they have a worse cardiovascular profile, yet fewer die of heart attacks and strokes.”
That may sound encouraging, but Lamas quickly issued a stern warning: “The rate of dying is statistically lower, but it’s still a risk of dying.”
Differences among Hispanics
What’s more, there are significant differences in mortality rates among the largest Hispanic subgroups — Mexicans, Puerto Ricans and Cubans — making the study of the U.S. Hispanic population more challenging.
In a report published online in January in JAMA Cardiology, researchers from Stanford University School of Medicine found that Puerto Ricans and Mexicans — in comparison to Cubans and non-Hispanic whites — were younger at the time of death from cardiovascular disease. Yet, Cubans and Puerto Ricans had higher rates of ischemic stroke (a restriction in blood supply to tissues) and hypertensive heart disease. Because not all Hispanics face the same level of mortality risk, physicians are calling for more research.
“Findings from this study suggest that aggregation of Hispanics as a single group fails to capture important differences in [cardiovascular disease] outcomes for this increasingly important and growing segment of the population,” the Stanford researchers wrote. “Public health efforts should be geared toward culturally appropriate interventions to reduce the burden of [cardiovascular disease] risk factors in this diverse population.”
Death rate differences aside, cardiologists continue to warn of high rates of cardiovascular disease among Hispanics. While many risk factors can be controlled by changes in lifestyle — eating healthier and exercising — not everyone is willing to make those changes.
There is a higher concentration of carbs in the Hispanic diet.We do love our pastelitos.
Dr. Sandra Chaparro, director of the Heart Failure Clinic at the University of Miami Miller School of Medicine
Martha Uribe, 34, was one person who did. The Pembroke Pines woman immediately changed her dietary choices after she was diagnosed with cardiomyopathy, a disease of the heart muscle. She eventually received a pacemaker and then a heart transplant, and attributes her survival to both the medical care she received and her lifestyle transformation.
Yet, she says family members aren’t learning from her experience, though cardiomyopathy runs on her father’s side. “I know a lot of people, mostly Hispanics like my family, who just load up on the white rice,” Uribe said. “They don’t stay away from the salt either.”
One of her physicians, Dr. Sandra Chaparro, director of the Heart Failure Clinic at the University of Miami Miller School of Medicine, said she is vigilant about informing patients that their choices play an important role.
“It’s important to let people know that how they manage their risk factors plays a big part in their health outcome,” Chaparro said. “It’s not just genetics. You can modify your diet, increase your exercise and pay attention to your numbers.”
At higher risk
Hispanics tend to have a higher incidence of risk factors for cardiovascular disease. Consider:
Overall, 12.8 percent of all Hispanics suffer from diabetes, compared with 7.6 percent of non-Hispanic whites. American Diabetes Association
▪ Diabetes. About 13 percent of Hispanic men and 11 percent of Hispanic women have been diagnosed with diabetes, but it’s estimated that an additional 7 percent and 5 percent, respectively, have the disease but don’t know it. Overall, 12.8 percent of all Hispanics suffer from the chronic disease, compared with 7.6 percent of non-Hispanic whites.
Diabetes is directly linked to cardiovascular problems. From 2009 to 2012, of all adults 18 years or older with diagnosed diabetes, 71 percent had high blood pressure and 65 percent had elevated cholesterol levels. In 2010, hospitalization rates for heart attacks were 1.8 times higher among adults with diagnosed diabetes than among adults without. Hospitalization rates for stroke were 1.5 times higher among diabetic adults, too.
▪ Obesity. More than 77 percent of Hispanic adults are overweight or obese, compared with 67.2 percent of non-Hispanic whites. And the numbers are more alarming among children. More than 38.9 percent of Latino children are overweight or obese, compared with 28.5 percent of non-Hispanic white children.
Physicians say there are many reasons for this disparity. “There is a higher concentration of carbs in the Hispanic diet,” Chaparro said. “We do love our pastelitos.”
The problem may be compounded, Chaparro added, because Hispanic families tend to favor fast food over more healthy alternatives. It’s a matter of both time and money.
Hispanics also tend to exercise less, certainly not the recommended 30 minutes daily.
“I’ve noticed, especially among the women, that they’re less likely to exercise than non-Hispanics,” said Dr. Natalie Regalado, an internal medicine practitioner with Baptist Health Primary Care.
She attributes this to several factors, from the fact that exercise may be less ingrained in the culture to women putting their needs last.
▪ Tobacco. While Hispanic adults have a lower prevalence of cigarette smoking and tobacco use than other ethnic groups, with the exception of Asian Americans, the rates vary among the subgroups. About 21 percent reported current use of a tobacco product in 2013, but that figure broke down as follows: 28 percent of Puerto Ricans, 19.8 percent of Cubans, 19.1 percent of Mexican Americans and 20 percent of other Central and South Americans.
The number of cigarettes smoked per day was highest among Cuban daily smokers — 50 percent of Cuban men and more than 35 percent of Cuban women reported smoking 20 or more cigarettes per day. Cigarette smoking leads not only to cardiovascular problems but also to cancer.
▪ Hypertension. Seventy-two percent of Hispanics had high blood pressure (hypertension), which is strongly linked to stroke, heart attack and heart failure, compared with 66 percent of non-Hispanic whites. Also, Hispanics, as well as African Americans, are less likely than whites to get their condition under control, according to research published in the American Heart Association journal. Part of the reason, researchers believe, is that Hispanics are less likely to receive drugs and/or intensive therapy for their condition.
To delve into Hispanic cardiovascular problems, local scientists continue to participate in research. UM , for example, is participating in The Hispanic Community Health Study / Study of Latinos (HCHS/SOL), a multi-center epidemiologic study that looks at the role of acculturation in the development of disease as well as the risk factors that play a harmful role. UM researchers also are taking part in studies of Smoking Cessation in Hispanic Construction Workers, Hispanic Secondary Stroke Prevention Initiative and one that explores left ventricular-assist devices in Hispanics.
Mount Sinai’s Lamas is recruiting patients for a research trial through the National Institutes of Health. Called TACT2 (for Trial to Assess Chelation Therapy), the trial examines the use of intravenous chelation therapy in combination with oral vitamins in the treatment of heart disease. TACT2 is a follow-up to a 10-year study that used chelation — a process by which a medication, in this case edetate disodium, grabs toxic metals within the body and helps their removal in the urine. The initial TACT showed a reduction in heart attack, stroke, death and other “heart events.”
Until these studies and others bear fruit, though, there is no replacement for clean living — and visits to the doctor.
Regalado, of Baptist Health, believes one key to improving compliance and treatment among Hispanics is for them to maintain a relationship with a primary care physician.
“Many people know they have to lose weight, exercise more and stop smoking and they don’t,” she said. “But I think that if they had continuing care and a long-term relationship with a primary care doctor who they trust, maybe the message would be easier to get across.”