Asian Americans and heart disease risk: Why one size does not fit all

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New research reveals stark differences in cardiovascular disease risk among different Asian American subgroups. Santi Nuñez/Getty Images
  • Asian Americans often have only one box to check on health forms — “Asian” — that lumps together a highly diverse population.
  • A new study takes a closer look at Asian American heart health hidden within that single checkbox.
  • The study finds considerable diversity in heart health among Asian Americans that is often overlooked.

Asian American people are typically categorized simply as “Asian” for the purposes of health research and reporting. It is a simplification that does not expose their true diversity.

A new large, retrospective study finds that some Asian American subgroups are at particular risk for ischemic heart disease, heart failure, and cerebrovascular disease.

Working with mortality data from 2011 to 2016 collected in the United States Centers for Disease Control and Prevention’s (CDC’s) National Health and Nutrition Examination Survey, the study reveals the flaw in considering the health of all Asian Americans as a single entity.

A recent analysis of the same data found that non-Hispanic Asians were more likely to have ideal cardiovascular health than non-Hispanic whites, missing entirely the higher cardiovascular risk associated with some Asian subgroups.

Dr. Pei Jai Michael Ho is a co-author of an editorial released alongside the new study. He told Medical News Today:

“Americans with Asian ancestry can trace their roots to more than 20 countries, ranging anywhere from China to the Indian subcontinent. These origins come with incredibly unique cultures, languages, and histories, including immigration status. Therefore, it is difficult to expect that these diverse individuals will face the same medical problems or have similar medical needs.”

“Lumping everyone with Asian ancestry into a single ‘Asian’ group masks potential healthcare disparities and makes it more challenging for our healthcare system to meet the needs of the unique subgroups in this population.”

– Dr. Pei Jai Michael Ho

Asian Americans are the fastest-growing demographic group in the U.S., increasing from 11.9 million people in 200 to 22.4 million people by 2019, which is an 88% increase.

The new study was published in the journal Circulation: Cardiovascular Quality and Outcomes.

While an accurate assessment of Asian Americans as a single group is difficult for risk factors such as obesity, type 2 diabetes, and hypertension, the new study focused on deaths from three cardiovascular disease categories:

  • Ischemic heart disease — A weakness in the heart muscle caused by an insufficient flow of blood and oxygen, ischemic heart disease can lead to heart attacks. It is also called “coronary artery” or “heart disease.”
  • Heart failure — When the heart muscle does not pump strongly enough, blood may back up, causing a fluid buildup in the lungs. This may cause swelling of the feet and legs, and shortness of breath.
  • Cerebrovascular disease — Restricted blood flow from the narrowing of blood vessels can cause blood clots, ruptures of blood vessels, or blockages. This can lead to strokes, aneurysms, and vascular malformations in addition to carotid, vertebral, and intracranial stenoses.

To determine age-standardized mortality rates from the three disease categories, the researchers compared deaths from all causes for 618,004 Asian Americans, 30,267,178 non-Hispanic white Americans, and 2,292,257 Hispanic Americans.

For the purposes of the study, Asian Americans were identified by the country from which they or their families migrated to the U.S.

Deaths from ischemic heart disease significantly decreased for all women over the period the data covered.

They also decreased for non-Hispanic white men, Hispanic men, and for Chinese, Filipino, Japanese, and Korean men. However, deaths remained stagnant for Asian Indian and Vietnamese men.

The highest number of deaths from ischemic heart disease was among Asian Indian women and men.

Hearth failure levels remained static for Chinese, Korean, and non-Hispanic white women, and Chinese and Vietnamese men. They significantly increased, however, for Filipino, Asian Indian, and Japanese women and men, as well as Korean men.

The greatest increases in terminal heart failure were for Asian Indian women and Asian Indian men.

Deaths from cerebrovascular disease fell for Chinese, Filipino, and Japanese women and men, and remained stagnant for Asian Indian, Korean, and Vietnamese women and men. Even so, Vietnamese women and men accounted for the highest number of cerebrovascular fatalities.

Dr. Ho told MNT, “It’s important to realize that no amount of racial subgrouping can adequately capture the ethnic makeup of the rapidly evolving U.S. population.”

“When an individual self-identifies as part of a racial/ethnic group, they may refer not just to their ancestral origin but also to multiple origins, to their own definition of what identifies a person as belonging to that group, and to their living experience with this identity,” he added.

“Racial subgroup disaggregation is a start toward capturing this information, but further research is needed.”

“This study should be only the beginning of a complicated subject and should start the conversation of how we can better care for our patients,” Dr. Ho said.

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