Risk Factor Prevalence Dangerously High, Poorly Controlled in Hispanic/Latino Adults

Fernando D. Testai, MD, PhD

A review of data from a longitudinal study of the health of people of Cuban, Dominican, Mexican, Puerto Rican, and Central and South American backgrounds is raising the alarm on increased prevalence of cardiovascular risk factors among Hispanic/Latino adults with a history of stroke.

Results of the study, which included data from more than 16,000 participants, suggested both high cholesterol and hypertension were present among more than half of the participants and more than 33% had a diagnosis of diabetes, but many were unaware of these conditions.

"It's a wake-up call for the medical community. Despite our best efforts, Hispanic and Latino populations still seem to be undertreated for their vascular risk factors," said Fernando D. Testai, MD, PhD, lead investigator and associate professor of neurology at the University of Illinois at Chicago, in a statement. “I didn't expect the numbers to be so dismal. We found many of the participants with previous stroke knew about their vascular risk factors; however, the data indicate they are receiving inadequate treatment and support, which are a real concern."

With an increased emphasis on identifying and addressing racial-based disparities in cardiovascular care, Testai and a team of colleagues at the University of Illinois hoped to provide a more accurate representation of the prevalence, awareness, and control of cardiovascular risk factors among Hispanic/Latino adults in the US. To do so, they designed the current study as an analysis of patients with a self-reported history of stroke or transient ischemic attack (TIA) from the Hispanic Community Health Study (HCHS)/Study of Latinos (SOL).

HCHS/SOL enrolled 16,145 Hispanic/Latino individuals aged 18-74 years from New York, Illinois, Florida, and California from March 2008-June 2011. From the study, investigators were able to obtain data related to the age, education, country of origin, household income, preferred language, years of residence in the United States among foreign-born participants, health insurance status, history of coronary heart disease, history of stroke/TIA, physical activity, and current cigarette smoking among study participants.

Of the 16,145 participants unclouded in HCHS/SOL, 404 had a self-reported history of stroke/TIA. Compared to those with no history of stroke/TIA, these patients were older, more likely to be men, had a longer residency in the US, lower household income, lower levels of education, and increased levels of vascular risk factors.

Among these patients, 59% had hypertension, 65% met criteria for dyslipidemia, and 39% had diabetes. When assessing awareness of these conditions, 90% were aware of their hypertension 75% were aware of their dyslipidemia, and 83% were aware of their diabetes status.

Among those who were aware of their risk factors, the prevalences of controlled hypertension, dyslipidemia, and diabetes were 46%, 32%, and 54%, respectively. When assessing medication use, results indicated 46% of participants were on antithrombotics, 39% were on statins, and 26% reported use of both, but investigators pointed out only 38% of those with atrial fibrillation reported use of anticoagulants.

In adjusted analyses, older age was associated with uncontrolled hypertension and diabetes. Other findings of note from these analyses included increased risk of uncontrolled diabetes among those in the US for 10 or more years or those born in the US and female sex being associated with uncontrolled dyslipidemia.

"Almost 80% of people in this study were overweight or obese, and a significant number continued to smoke despite having a history of stroke and other cardiovascular events. Access to care is another important area that we need to address to reduce cardiovascular risk in this population,” Testai added.

This study, “Stroke Risk Factor Status and Use of Stroke Prevention Medications Among Hispanic/Latino Adults in HCHS/SOL,” was published in Stroke.