Results from a study conducted by investigators at Stanford University School of Medicine did not support the Hispanic paradox in a highly educated Hispanic population. The study demonstrated that Hispanic and non-Hispanic white (NHW) men and women with high educational attainment had similar atherosclerotic cardiovascular disease risk, subclinical coronary atherosclerosis, and mortality during follow-up. The results were published online in the latest issue of JAMA Cardiology.
Hispanic individuals are the fastest growing ethnic group in the United States and face lower socioeconomic status compared with non-Hispanic white (NHW) individuals. These individuals are the largest minority group in the United States and experience a disproportionate burden of atherosclerotic cardiovascular disease (ASCVD) risk factors. However, Hispanic individuals tend to experience better health outcomes than expected, a phenomenon known as the Hispanic paradox. Little is known about how higher socioeconomic status is associated with Hispanic cardiovascular risk factor burden and outcomes. To determine cardiovascular risk and outcomes among highly educated Hispanic vs NHW individuals in a preventive medicine clinic, a team of investigators led by Dr. Fatima Rodriguez conducted a retrospective cohort analysis of participants from the Cooper Center Longitudinal Study who underwent preventive medical examinations at the Cooper Clinic in Dallas, Texas, from October 1972 to November 2017. The analysis was commenced in April 2018. The primary outcome measured was the prevalence of major metabolic risk factors. Cardiorespiratory fitness was compared, as were changes among participants with at least 2 visits. Ethnic differences adjusted for age, examination year, and educational attainment were estimated using regression models. Age-matched comparisons of coronary artery calcium scores were performed. All-cause mortality was summarized using the Kaplan-Meier method.
“Our study challenges the well-described epidemiologic association between high SES and improved health outcomes. We found a high prevalence of adverse cardiovascular risk profiles (namely obesity, metabolic syndrome, and diabetes) in a highly educated and largely employed cohort of Hispanic individuals. After adjusting for educational attainment, there was no difference in predicted ASCVD risk between Hispanic and NHW individuals. In support of these findings, prior work has shown an inverse association between educational attainment and diabetes risk among Hispanic individuals. A possible explanation for our findings is those study participants were highly acculturated to the US culture. Increased acculturation has been linked to higher rates of obesity, hypertension, diabetes, and risk of cardiovascular disease.”- Dr. Fatima Rodriguez, M.D.
This study included 1351 Hispanic and 43,736 NHW participants aged 20 to 80 years, body mass index between 18.5 and 50.0, and were not missing key cardiometabolic or fitness variables. Both Hispanic and NHW participants had high educational attainment, with a mean of more than 15 years of total education. Hispanic women and men had a higher prevalence of metabolic syndrome (71 of 518 [13.1%] vs 1477 of 13 732 [10.8%] for women and 255 of 833 [30.6%] vs 7902 of 30004 [26.3%] for men, respectively). Although Hispanic individuals were twice as likely to have diabetes, there was no difference in calculated 10-year atherosclerotic cardiovascular disease risk scores by ethnicity. Both Hispanic andNWH individuals experienced a statistically significant worsening in cardiometabolic parameters during follow-up, although this was not statistically significantly different between groups. In age-matched analyses, there were no significant differences in the prevalence of coronary artery calcium scores between Hispanic and NWH individuals. During a mean (SD) follow-up of 12.9 (7.5) years, there was also no difference in mortality between Hispanic and NHW individuals.
“In a longitudinal cohort of individuals with higher SES undergoing preventive health examinations, Hispanic and NHW men and women with high educational attainment have similar ASCVD risk, subclinical coronary atherosclerosis, and mortality during follow-up. These findings do not support the Hispanic paradox in a highly educated Hispanic population. However, more work is needed to understand the relationship between SES, cardiovascular risk, and outcomes in Hispanic individuals.”- Dr. David J. Maron, M.D.
Therefore, the investigators concluded that in a highly educated Hispanic population, there was no evidence for the Hispanic paradox in cardiovascular risk, subclinical coronary atherosclerosis, or mortality. Speaking of the strengths of their study, the investigators claimed, “Our study has several strengths. We studied a cohort of highly educated Hispanic individuals who have not traditionally been included in prior studies exploring the Hispanic paradox in ASCVD. We were able to compare Hispanic participants with NHW participants of similar SES. Second, our cohort is well characterized with thoroughly measured data on the burden of cardiovascular risk factors, fitness, subclinical atherosclerosis (CAC), and mortality. Finally, we were able to follow the participants longitudinally, a major limitation of prior studies that have focused on cross-sectional associations between Hispanic individuals and ASCVD outcomes.” Thus, the investigators have proven that in a longitudinal cohort of individuals with higher SES undergoing preventive health examinations, Hispanic and NHW men and women with high educational attainment have similar ASCVD risk, subclinical coronary atherosclerosis, and mortality during follow-up. These findings do not support the Hispanic paradox in a highly educated Hispanic population. However, they acknowledge the fact that more work is needed to understand the relationship between SES, cardiovascular risk, and outcomes in Hispanic individuals.
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