Cardiovascular mortality in Hispanics compared to non-Hispanic whites: A systematic review and meta-analysis of the Hispanic paradox
Cardiovascular mortality in Hispanics compared to non-Hispanic whites: A systematic review and meta-analysis of the Hispanic paradox
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DOI：
10.1016/j.ejim.2013.09.003
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发表时间：
2013-12-01
影响因子：
8
通讯作者：
Lopez-Jimenez, Francisco
中科院分区：
文献类型：
--
作者：
Cortes-Bergoderi, Mery;Goel, Kashish;Lopez-Jimenez, Francisco
背景：西班牙裔美国人是美国最大的少数民族。美国，与非西班牙裔白人（NHW）相比，几种心血管（CV）风险因素的患病率更高。然而，一些研究显示，西班牙裔人群的CV事件发生率低于NHW.Objective：对美国西班牙裔和NHW人群的CV死亡率和全因死亡率进行比较的队列研究进行系统综述和荟萃分析。我们检索了1950年至2013年5月的EMBASE、MEDLINE、Web of Science和Scopus数据库，使用与西班牙裔种族、CV疾病和队列研究相关的术语。我们汇集了风险估计使用最少和最调整模型的每个publish.Results：我们发现341出版物，其中17个符合纳入标准;数据代表22，340，554西班牙裔和88，824，618 NHW，收集自1950年至2009年。其中12项研究按性别对分析进行了分层，一项研究按出生地对人们进行了分层。G.联合S.-出生，墨西哥出生，和中美洲/南美洲出生）。西班牙裔与较低的CV死亡率（OR 0.67; 95%CI，0.57-0.78; p < 0.001）和较低的全因死亡率（0.72; 95%CI，0.63-0.82; p < 0.001）之间存在统计学显著相关性。仅包括报告CV风险因素患病率的研究的亚组分析发现了相似的结果。西班牙裔CV死亡率的OR为0.49; 95%CI 0.30-0.80; p值< 0.01;全因死亡率的OR为0.66; 95%CI 0.43-1.02; p值0.06。结论：西班牙裔CV死亡率存在悖论。需要进一步的研究来确定在西班牙裔中介导这种保护性CV效应的机制。(C)2013年欧洲内科联合会。Elsevier B. V.出版，保留所有权利。
Background: Hispanics, the largest minority in the U. S., have a higher prevalence of several cardiovascular (CV) risk factors than non-Hispanic whites (NHW). However, some studies have shown a paradoxical lower rate of CV events among Hispanics than NHW.Objective: To perform a systematic review and a meta-analysis of cohort studies comparing CV mortality and all cause mortality between Hispanic and NHW populations in the U.S.Methods: We searched EMBASE, MEDLINE, Web of Science, and Scopus databases from 1950 through May 2013, using terms related to Hispanic ethnicity, CV diseases and cohort studies. We pooled risk estimates using the least and most adjusted models of each publication.Results: We found 341 publications of which 17 fulfilled the inclusion criteria; data represent 22,340,554 Hispanics and 88,824,618 NHW, collected from 1950 to 2009. Twelve of the studies stratified the analysis by gender, and one study stratified people by place of birth (e. g. U. S.-born, Mexican-born, and Central/South American-born). There was a statistically significant association between Hispanic ethnicity and lower CV mortality (OR 0.67; 95% CI, 0.57-0.78; p < 0.001), and lower all-cause mortality (0.72; 95% CI, 0.63-0.82; p < 0.001). A subanalysis including only studies that reported prevalence of CV risk factors found similar results. OR for CV mortality among Hispanics was 0.49; 95% CI 0.30-0.80; p-value < 0.01; and OR for all-cause mortality was 0.66; 95% CI 0.43-1.02; p-value 0.06.Conclusion: These results confirm the existence of a Hispanic paradox regarding CV mortality. Further studies are needed to identify the mechanisms mediating this protective CV effect in Hispanics. (C) 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.