Study Details Significant Differences in CV Mortality Among Subgroups of Asian Americans

A new analysis is providing insight into the differences in cardiovascular disease among various Asian ethnicity subgroups in the US over the last 20 years.

An analysis of data from the by investigators at Northwestern University’s Feinberg School of Medicine, results of the study highlight notable differences in cardiovascular and cerebrovascular mortality trends in Asian American subgroups within the US.

“For a long time, because Asian Americans were grouped into one category, it appeared that Asian people in the U.S. did not have as high a risk for heart and vascular diseases compared with other groups,” said Nilay S. Shah, MD, MPH, an assistant professor of cardiology and preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago and an affiliated global faculty member at Stanford University’s Center for Asian Health Research and Education, in a statement from the American Heart Association. “Our findings indicate this is inaccurate. By separating Asian subgroups, we can identify populations and communities that are at higher cardiovascular disease risk, and they may benefit from enhanced heart disease prevention and treatment strategies.”

Although Asian Americans comprise the fastest-growing race and ethnic group in the US, they represent an understudied portion of the overall population. Citing previous studies that have failed to differentiate between specific subgroups of Asian American patients, Shah and a team of colleagues undertook the current study to provide clinicians with insight into mortality trends in different Asian American subgroups in the US using death certificate data from the National Center for Health Statistics.

The specific Asian American subgroups included in the study were Chinese, Asian Indian, Filipino, Japanese, Korean, and Vietnamese American. Investigators also included dements of non-Hispanic White and Hispanic ethnicity for comparison. The primary outcome of interest for the investigators’ analyses was the age-standardized mortality rates (ASMR) according to subgroup for each year in the study period. Investigators pointed out 2003-2017 was chosen as the study period because revisions to the US Standard Certificate of Death in 2003 allowed for the identification of Asian American subgroups and 2017 represented the most recent available data in disaggregated Asian American subgroups.

Results of the investigators’ analyses demonstrated mortality rates from ischemic heart disease decreased significantly during the study period among all subgroups of women and significantly decreased among Chinese, Filipino, Japanese, Korean, Non-Hispanic White, and Hispanic men, but remained stagnant among Asian Indian and Vietnamese men. Among the subgroups of interest, the highest mortality rates for ischemic heart disease in 2017 were observed among Asian Indian men and women, with rates of 77 and 133 per 100,000, respectively.

When assessing mortality from heart failure, results indicated heart failure ASMRT remained stagnant among Chinese, Korean, and non-Hispanic White women as well as Chinese and Vietnamese men. Results also suggested ASMR had increased significantly among both sexes in Filipino, Asian Indian, and Japanese Individuals. Additionally, significant increases in heart failure ASMR were observed for Vietnamese women and Korean men, with the highest 2017 ASMR for Asian American subgroups observed among Asian Indian men and women, with rates of 15 and 14 per 100,000, respectively.

For cerebrovascular disease ASSMR, results pointed to decreased rates among Chinese, Filipino, and Japanese women and men during the study period. Stagnant ASMRs were observed among Asian Indian, Korean, and Vietnamese women and men and the highest cerebrovascular disease in 2017 were observed among Vietnamese men and women, with rates of 47 and 46 per 100,000, respectively.

In a related editorial, Monica Parks, MD, Brahmajee Nallamothu, MD, MPH, and P. Michael Ho, MD, PhD, commend the study’s investigators for their contributions to the current knowledge base and calling attention to gaps in care for Asian American patients.

“It is increasingly clear that not only has the ethnic makeup of the U.S. population changed, but the aggregate living experiences of these communities have evolved and may drive wildly different interactions with the health care system. Simple checking of a box next to “white” or “Asian American” is insufficient to capture such complexity,” the trio wrote.

This study, “Cardiovascular and Cerebrovascular Disease Mortality in Asian American Subgroups,” was published in Circulation: Cardiovascular Quality and Outcomes.