Background:
Non-Hispanic Asian Americans (AA) are one of the fastest growing populations in the U.S., yet little information is known about the cardiovascular health (CVH) of this group. The objective of this study was to assess the CVH of AA using a nationally representative survey.
Methods:
Merging data from the National Health and Nutrition Examination Surveys (NHANES) in 2011-2012 and 2013-2014, we examined 7 metrics of CVH using national guidelines and recommendations: not smoking, normal weight (body mass index, BMI <25 kg/m
2
)
,
adequate physical activity, healthy diet, normal blood cholesterol , normal blood glucose and normal blood pressure. Each CVH metric was weighted evenly, with scores for each metric being a 0 (not meeting standards) or 1 (meeting current standards), and the metrics were summed for a total score. Ideal CVH (ICVH) was defined as the percentage of those meeting recommendations for 6-7 metrics, and poor CVH (PCVH) defined as those meeting only 0-2. We compared the prevalence of ICVH and PCVH between non-Hispanic whites (NHW) and AA, as well as among AA by birthplace and years living in the U.S. We also assessed the adjusted prevalence ratios (APR, 95% Confidence Intervals [CI]) of ICVH for AA, using NHW as referent, controlling for age, sex, education, and health insurance status. Additional sensitivity analyses were performed using a previously established Asian-specific normal weight cut-point (BMI<23 kg/m
2
) for AA.
Results:
In adjusted models, AA were more likely to not smoke, have a normal weight, report a healthy diet and have normal blood pressure, compared with NHWs. However, NHWs were more likely to have normal blood glucose compared with AA, and no difference was identified with reported physical activity and blood cholesterol. The adjusted prevalence of ICVH was 9.2% for AA and 5.7% for NHWs (p<0.01). The adjusted percentage for PCVH was 26.6% for AA and 33.5% for NHWs (p<0.01). AA were significantly more likely to have ICVH (APR 1.41, 95% CI: 1.25-1.60) compared to NHW, but there was no difference in ICVH comparing US-born and foreign-born, nor by years living in the US. Additional sensitivity analyses using lower BMI thresholds for AA, consistently found a higher percentage of normal weight AA compared with NHW (36.4% vs 30.4, p<0.01); with no differences in the adjusted prevalence of ICVH (6.7% vs 5.7%, p=0.4) and PCVH (30.8% vs 33.5%, p=0.2) between AA and NHW (APR 1.18, 95% CI: 0.84-1.66).
Conclusion:
AA currently account for 5.3% of adult population in the US, and have been identified as one of the fasting growing minority populations. In this study, AA had a higher prevalence of overall ICVH compared with NHWs; however, when using a lower BMI threshold for AA as recommended by some, there was no difference of ICVH between AA and NHW. Using unique risk scores for AA may better identify AA with less than ideal cardiovascular health.
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