SDSU Study: Heart Disease Risk Factors Vary Among U.S. Hispanics/Latinos
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November 6, 2012 1:22 p.m.
Dr. Greg Talavera, professor, Graduate School of Public Health, SDSU, principal investigator for the HCHS/SOL Field Center
CAVANAUGH: Our top story on Midday Edition, the campaigns are over. Today voters make their choices. So we leave you to those political decisions and focus on issues other than politics. In the largest and most comprehensive study of its kind, new medical research has compiled information on heart disease risk factors among Hispanic Latino communities in the U.S. joining us to share this information and what it means is my guest, doctor Greg Talavera. His paper on the Hispanic community health study will be published tomorrow in the journal of the American medical association. Thank you for coming in and joining us.
TALAVERA: Thank you for having me, Maureen.
CAVANAUGH: First of all, the terms Hispanic Latino are used throughout this study. Does this indicate that the research spans different communities across the United States?
TALAVERA: That's correct. The terms Hispanic and Latino have political ramifications. And for our study, we wanted to be most inclusive. So we've used that term with the slash to indicate individuals living in the United States that are of Hispanic/Latino background. And we try to avoid the use of the term ethnic minority. Some have emigrated here at time, and others are second and third generation like myself.
CAVANAUGH: And what were the areas that were focused on in this study? Not just Southern California?
TALAVERA: Correct. The study represents results from a population-based study conducted for communities in the United States. Here in San Diego, Chicago, the Bronx, and Miami. All working together in a collaborative fashion to conduct the study in a similar protocol and analyze our data together.
CAVANAUGH: And was that to find communities whose Hispanic/Latino heritage did not all come from one country?
TALAVERA: That's correct. This study sponsored by the NIH, and one of their goals was to get representation from the diverse background groups that comprise our Hispanic/Latino community in the United States. So cities and sites for conducting the study were chosen with that somewhat in mind.
CAVANAUGH: So your findings about the prevalence of heart disease risk factors among the Latino Hispanic community is in some ways really eye-opening. Give us an idea of how many in these communities are at risk. What are the statistics?
TALAVERA: Well, the results represented in detail in tomorrow's edition. But the headline news is that 80% of men and 71% of women in our cohort had at least one risk factor for heart disease.
CAVANAUGH: And what are the heart disease risk factors that you looked at?
TALAVERA: The major cardo vascular risk factors are smoking, high cholesterol, hypertension, obesity, and some other ones like, you know, depression, inflammatory markers and things like that. But we focused on the ones -- we published the ones that were most important for clinicians and public health specialists.
CAVANAUGH: And how do those percentages that you just gave us, how does that compare with the studies about the general U.S. population?
TALAVERA: Well, that's a good question. These are preliminary results. And we have not yet compared our results with other samples in the United States. So really we're just focusing -- this is the first of many, many papers to come, and they're really just presented right now for clinical and public health implications right now. So we can't compare them to the general population just yet. Although future manuscripts will address that issue.
CAVANAUGH: Are certain of these heart disease risk factors in your study more prevalent in the different communities that you studied than they are just across the board in the Hispanic/Latino community?
TALAVERA: Yes, in fact that's one of the goals of the study and the paper. We want to make clinicians, the public community aware that the Hispanic/Latino term, the population is not homogeneous. We find risk factors from one background group to another. Mexican American men in San Diego demonstrated the highest rate of diabetes compared to the other background groups in our study. Mexican American women were the second highest in terms of diabetes. So that's the type of message that we're trying to get out right now, that we're not all the same. For instance in the Bronx and somewhat in Chicago, the Puerto Rican background groups had higher prevalence of other risk factors. So we're trying to educate the public community and the health community on these background group variations and we are not really one homogeneous group as previous literature has suggested.
CAVANAUGH: You also found risk factored increased in these communities with the degree of Acultureration. What do you mean by that term?
TALAVERA: Well, it's a difficult thing to describe and measure. We did our best in the study. But in general, Aculturation measures the degree that someone -- particularly immigrate to the United States begins to adopt lifestyle factors that have an impact on cardiovascular risk factors. It has other meanings in other settings. But for us as cardiovascular researchers, what impact does it have living in the United States being exposed to different food environment, physical activity environment, and in terms of pill-taking behavior, how that impacts cardiovascular disease. So our studies suggest that individual who is have less than a high school education, individuals that have incomes that are below $20,000 and individuals that spend more time in the United States, if they immigrated here, and lastly if you were born here all tend to have higher risk factor profiles than the less Aculturated, so to speak.
CAVANAUGH: And is there anything specific that we know what's causing that? Is it mainly diet? Is it lifestyle?
TALAVERA: Yeah, we have the ability to -- that's what's unique about this study. We have information, and we're just beginning to analyze it, but we will have the ability to examine both genetic, psychosocial and lifestyle factors, as well as clinical and biological markers in the future. I can't speculate on those causations right now because it's baseline data, cross-sectional data. You can't make cause and effect inferences there. But if you look at the other literature that's out in the general population, everything suggests that the more we tend to have an American lifestyle, or a western lifestyle, the more risk factors you have. So that's one of the working theories that we're going to be exploring, you know, to what degree to first-generation immigrants adopt these lifestyles over time, and the same thing with the second and third generation background groups. But definitely as we all know, eating fast food frequently, not exercising, these risk factors, especially obesity, are epidemic right now. The obesity epidemic doesn't have any -- it's not color blind. It's in all populations right now. Although it is affecting some of our Latino back ground groups more than others. But that's the theory behind the Aculturation, the education, and so forth. And for sure, poverty plays a role in all of that.
CAVANAUGH: I was just going to ask you that. I saw in the information I was given that the relative wealth or poverty of the subjects you studied was also a factor.
TALAVERA: Yeah. And that's true in all populations here in the United States. The ability to buy fresh fruits and vegetables, the ability to access stores where those are available are largely dependent on your environment. If you're in a poverty-stricken area of a community, then you have to sometimes go to the liquor store. This is the food desert concept. If you think about it, who are the poorest in our country? It's general the people of color, the racial and ethnic minorities. Not surprisingly, if you look outside of the literature, you'll find that racial and ethnic minorities does suffer quite a big from these risk factors as a consequence of being poor and not well-educated.
CAVANAUGH: I'm wondering, how is this research information likely to be used in a clinical setting?
TALAVERA: Well, as I mentioned before, when we get the message out to clinicians, they will -- let's take the diabetes as an example. To a clinician working in a Hispanic/Latino community that is predominantly of Mexican background, knowing that they have some of the highest rates of diabetes amongst all Hispanic/Latino populations, they will be more likely to screen for them. Maybe change their clinical suspicion that someone has diabetes. For the public health community, the same thing goes. If you are doing public health in a community which is largely Mexican background, you will probably want to increase your campaign for awareness and early detection of diabetes. Maybe even think about prescreening people with prediabetes, and things like that. So we're working to get the message out to impact clinical care and create more public health awareness of these regional variations.
CAVANAUGH: And are some going to follow these particular participants in the study?
TALAVERA: Yes. We are going to be confirming some of our early findings. All four cities are expected to continue to follow the cohort. We will stay in contact with them annually and call them up and ask them questions about their health, have they been to the emergency room or had surgeries, go after medical records and confirm some of our early findings. The outcome of heart attack and stroke is currently self-reported only in our data. But with time, we'll be able to verify these things with medical records and validate them over time as we go forward and have continued contact with them. So that's the value of the study. We'll get more accurate information, we'll get more data that is what we call prospective, and not just historical. Some of this relies on their memory to recall what happened.
MAUREEN CAVANAUGH: Not only is your paper being published but cardiac researchers from across the country are meeting at a symposium.
TALAVERA: Mark Sussman, one of my colleagues here at San Diego state who does basic science research will be hostingly researchers from four universities and half a dozen other institutes around the world to discuss new and groundbreaking discoveries in stem cell biology, developmental cell biology, and other highly specialized fields of environmental research that will benefit cardiac patients worldwide. So he's kind of at the other end of the spectrum, doing basic science research, but it just highlights the diversity and the health of research that's taking place here at San Diego state university.
CAVANAUGH: You're going out to people and finding out what their lifestyles are like, and what kind of problems they have had in certain communities. And on the other side, they're trying to go to the cellular level and find out what the problem is with heart disease. Cardiovascular disease remains one of the leading causes of death around the world. Some medical experts say if we changed our lifestyles, we could possibly avoid heart disease all together. Do you go with that or do you think it's more complicated than that?
TALAVERA: Well, I think we can definitely do better than what we're currently doing. But in the world of clinical medicine, behavior change among patients and participants is very, very challenging. It's easy to prescribe a medicine to control high blood pressure. But it's hard to get the patient to comply or adhere to that treatment protocol. So yeah, I think a large portion ever the cardiovascular death and disability that we saw in the United States and worldwide could be reduced significantly. Whether or not we could eliminate it, that's a challenge. Most health conditions that we experience as humans are a combination of genetic factors, environmental factors, and clinical access to care. What you're talking about is the access to clinical care,. And that would bring down the rate that we have right now.