Heart, Stroke Risks Vary in Asian, NHPI Adults

Research Highlights:

• The prevalence of cardiovascular disease risk factors varies greatly among Asian American, Native Hawaiian and other Pacific Islander (AANHPI) populations, according to an analysis of electronic health records for more than 700,000 adults in California and Hawaii.
• The 10-year predicted risk of a major cardiovascular event, such as a heart attack, stroke or heart failure, also varied among the different groups.
• These results highlight differential risks and raise awareness for the importance of identifying and managing cardiovascular disease risk factors in high-risk populations, the researchers noted.
• Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association's scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal.

NEW ORLEANS, March 6, 2025 — Asian American, Native Hawaiian and other Pacific Islander (AANHPI) populations experienced differences in both cardiovascular disease predicted risk and risk factors, according to preliminary research presented at the American Heart Association's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2025. The meeting will be held in New Orleans, March 6-9, 2025, and features the latest science on population-based health and wellness and implications for lifestyle.

Previous research has noted important differences in the prevalence of heart disease and stroke risk factors among AANHPI subgroups, including an elevated death rate from cardiovascular disease (CVD) in Native Hawaiian and Pacific Islander adults compared to non-Hispanic white adults in the U.S. Additionally, according to the U.S. Department of Health and Human Services, Native Hawaiian and Pacific Islander adults were 10% more likely to be diagnosed with coronary heart disease than non-Hispanic white adults in 2014.

"Historically, Asian American, Native Hawaiian and other Pacific Islander populations have frequently been grouped together as a single, homogenous racial and ethnic group in clinical and epidemiologic research, which masks important variations in both risk factor prevalence and disease burden," said lead study author Rishi V. Parikh, M.P.H., a senior research analyst at the Kaiser Permanente Northern California Division of Research in Pleasanton. "Despite being the fastest growing population in the U.S., existing studies about Asian subgroups remain limited by inadequate sample size and exclusion of some major disaggregated subgroups, as well as a lack of long-term follow up."

In the PANACHE (Pacific Islander, Native Hawaiian and Asian American Cardiovascular Health Epidemiology) study, researchers analyzed health records from 2012 through 2022 for approximately 700,000 adults enrolled in large private health systems in California and Hawaii. Participants in the study included adults who self-identified as Chinese, Filipino, Native Hawaiian or other Pacific Islander, Japanese, Korean, Vietnamese, other Southeast Asian (including Thai, Laotian, Cambodian, Hmong, Burmese, Indonesian, Malaysian or Singaporean) or South Asian (including Indian, Pakistani, Sri Lankan, Bangladeshi, Nepali or Bhutanese).

Researchers compared the prevalence of traditional cardiovascular disease risk factors among adults belonging to only one of the AANHPI subgroups who had not been previously diagnosed with cardiovascular disease. For direct comparison, the researchers also analyzed the prevalence of cardiovascular risk factors for 2 million non-Hispanic white adults in the same health system databases.

The analysis found:

• High blood pressure prevalence ranged from 12% in Chinese adults to 30% in Filipino adults.
• High cholesterol prevalence ranged from 20% in Chinese adults to 33% in Filipino adults.
• Obesity ranged from 11% in Vietnamese adults to 41% in Native Hawaiian/Pacific Islander adults. In this study, researchers classified obesity as a BMI greater than or equal to 30 kg/m² for non-Hispanic white and Native Hawaiian/Other Pacific Islander adults, and greater than or equal to 27.5 kg/m² for all other adults in an Asian subgroup, in accordance with the World Health Organization's criteria.
• Type 2 diabetes prevalence ranged from 5% in Chinese adults to 14% in Native Hawaiian/Pacific Islander adults.
• Smoking ranged from more than 13% in Native Hawaiian/Pacific Islander adults to less than 10% in all other AANHPI subgroups.
• All AANHPI subgroups had higher prevalences of Type 2 diabetes and high cholesterol in comparison to non-Hispanic white adults.
• Using the American Heart Association's PREVENT^TM risk calculator, the researchers found that the 10-year predicted risk for a cardiovascular event was highest in Native Hawaiian/Pacific Islander adults, and Filipino, South Asian and other Southeast Asian populations also had higher 10-year cardiovascular disease risk than non-Hispanic white adults.

"At the individual patient level, our findings along with previous work suggest that regular monitoring of risk factors like blood pressure and cholesterol may be helpful for early detection of increased risk and prevention of cardiovascular disease among Asian American, Native Hawaiian and Pacific Islander populations," said study co-author Alan S. Go, M.D., an associate director of the Kaiser Permanente Northern California Division of Research (Cardiovascular and Metabolic Conditions Research).

"A next step for the PANACHE study will be a population-based survey to describe risk factors not routinely available in the electronic health record (such as immigration history, generational status, employment history, other social determinants of health, experiences of discrimination, acculturation, diet, physical activity, and access to health care services and other resources) that may be unique to each subgroup and how they may influence the risk of cardiovascular disease. These additional data will help us understand sources of health disparities and inform tailored cardiovascular prevention strategies for AANHPI individuals, both in the clinic and in the community."

Study details, background and design:

• The researchers analyzed cardiovascular disease risk factors in 2,653,007 adults residing in California or Hawaii (677,563 AANHPI adults and 1,975,44 non-Hispanic white adults). Participants were ages 30 years or older (average age of 49); 53% of participants identified as female, and 47% identified as male.
• People previously diagnosed with heart attack, stroke, heart failure or atrial fibrillation or those who identified with more than one racial/ethnic group were excluded from the analysis.
• Data were collected from hospital/health system electronic health records from 2012 through 2022.
• The 10-year risk of cardiovascular disease events was calculated using the American Heart Association's PREVENT risk calculator equations. The researchers standardized the risk of cardiovascular disease events to the overall age and sex distribution of the total participant pool to account for the variability within the sub-groups.
• PREVENT estimates risk of cardiovascular disease using sex-specific equations; incorporating markers of kidney disease in addition to HbA1c measures to help assess metabolic health; estimates 10-year and 30-year risk for heart attack or stroke as well as heart failure; and considers additional risk factors associated with the Social Deprivation Index. The Social Deprivation Index is a composite measure based on seven demographic characteristics collected in the American Community Survey, including poverty rate, education level, employment, access to transportation, household characteristics (single-parent households), percentage of households that rent rather than own housing and percentage of households that are overcrowded.

The study had several limitations, including that it may not be fully representative of adults without health insurance, who live in other areas of the U.S., or those who live outside the U.S. In addition, health measurements were collected through routine clinical care via electronic health records, which may not include adults who do not use health care services or those who face barriers to accessing health care. Future studies will involve examining underlying factors that may contribute to the diverse risks among various AANHPI subgroups, the researchers said.

"While cardiovascular disease remains the leading cause of death for all Americans, understanding differences among specific population groups can identify gaps in monitoring and management of risk factors, such as obesity, hypertension and Type 2 diabetes," said Sadiya S. Khan, M.D., M.Sc., FAHA, chair of the writing group for the Association's 2023 scientific statement for the PREVENT risk calculator tool. Khan is the Magerstadt Professor of Cardiovascular Epidemiology and an associate professor of medicine and preventive medicine at the Northwestern University Feinberg School of Medicine and a preventive cardiologist at Northwestern Medicine, both in Chicago, and was not involved in the study.

"These findings further underscore that Asian Americans represent a diverse and heterogeneous group, and research should prioritize inclusion and appropriate identification of Asian Americans and various subgroups to improve cardiovascular health for all."

Moderated Poster Presentation MP32 in Session MP06 Cardiometabolic Health and Disorders is Friday, March 7, 2025 at 5:00 p.m. CT.

Co-authors, their disclosures and funding sources are listed in the abstract.

See Also: Additional abstract presentations (presentations P1018, P1085, P2085) at the Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions from the PANACHE study will report on newly diagnosed cardiovascular disease cases during the 11-year 2012-2023 study period.

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