Coronary Death and Myocardial Infarction among Hispanics in the Northern Manhattan Study: Exploring the Hispanic Paradox

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• 作者：Joshua Z. Willey ; MD ; MS^a ; ^{jzw2@columbia.edu} ; Carlos J. Rodriguez ; MD ; MPH^e ; ^f ; Yeseon Park Moon ; MS^a ; Myunghee C. Paik ; PhD^b ; Marco R. Di Tullio ; MD^c ; Shunichi Homma ; MD^c ; Ralph L. Sacco ; MD ; MS^f ; Mitchell S.V. Elkind ; MD ; MS^a ; ^d
• 关键词：Hispanic ; Paradox ; Mortality ; Cardiovascular Disease
• 刊名：Annals of Epidemiology
• 出版年：2012
• 期刊代码：15_10472797
• 类别：med
• 出版时间：May, 2012
• 卷：22
• 期：5
• 页码：303-309
• 文件大小：110 K

摘要

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Purpose

Prior studies have reported that Hispanics have lower cardiovascular disease (CVD) mortality despite a higher burden of risk factors. We examined whether Hispanic ethnicity was associated with a lower risk of nonfatal myocardial infarction (MI) coronary death (CD) and vascular death.

Methods

A total of 2671 participants in the Northern Manhattan Study without clinical CVD were prospectively evaluated. Cox models were used to calculate hazard ratios (HR) and 95%confidence intervals (CI) for the association of race-ethnicity with nonfatal MI, CD, and vascular death after adjusting for demographic and CVD risk factors.

Results

Mean age was 68.8 (10.4) years; 52.8%were Hispanic (88%Caribbean-Hispanic). Hispanics were more likely to have hypertension (73.1%vs. 62.2%, p < .001) and diabetes (22.0%vs. 13.3%, p < .001), and less likely to perform any physical activity (50.1%vs. 69.2%, p < .001) compared to non-Hispanic whites (NHW). During a mean 10 years of follow-up there were 154 nonfatal MIs, 186 CD, and 386 vascular deaths. In fully adjusted models, Hispanics had a lower risk of CD (adjusted HR = 0.36, 95%CI: 0.21-0.60), and vascular death (adjusted HR = 0.62, 95%CI: 0.43-0.89), but not nonfatal MI (adjusted HR = 0.95, 95%CI: 0.56-1.60) when compared to NHW.

Conclusions

We found a 鈥淗ispanic paradox鈥?for coronary and vascular deaths, but not nonfatal MI.