Cardiovascular health in Hispanics/Latinos: a reexamination of the Hispanic paradox.
Cardiovascular health in Hispanics/Latinos: a reexamination of the Hispanic paradox.
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西班牙裔/拉丁裔的心血管健康：西班牙裔悖论的重新审视。
DOI：
10.1111/jch.12941
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Schoenthaler,AntoinetteM
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文献类型：
--
作者：
Schoenthaler,AntoinetteM
高血压是导致美国心血管(CV)相关死亡率和医疗支出高的唯一最重要的因素。尽管高血压造成了沉重的负担，但数十年的研究表明，拉美裔/拉美裔美国人是美国增长最快的种族群体，与非拉美裔白人相比，他们的特定心血管疾病死亡率和全因死亡率较低。这一现象被称为拉美裔悖论-尽管拉美裔/拉美裔比非拉美裔白人的简历风险特征明显较差(例如，肥胖率、低血糖、糖尿病和较低的体力活动率)，但这种现象仍然存在。1虽然已经提出了许多理论来支持或驳斥这一悖论(即鲑鱼偏见假说、健康的移民效应、更好的社会支持)，但许多理论未能解释拉美裔/拉丁裔人口日益增长的异质性。相反，墨西哥裔美国人最常出现在心血管疾病的研究中，这可能掩盖了不同的西班牙裔/拉丁裔亚群中高血压的真正负担。例如，西班牙裔社区健康研究/拉美裔研究(HCHS/SOL)的最新数据表明，墨西哥裔美国人的高血压患病率最低(21.7%)，而古巴、多米尼加和波多黎各背景的人高血压患病率最高(范围：31.5%-32.2%)。2在血压控制方面也出现了类似的模式，40岁以下的参与者(血压控制20%)以及中美洲和多米尼加男性(分别为12%和27%)的血压控制率最低。与所有其他拉美裔/拉丁裔群体相比，波多黎各背景的个人也更有可能肥胖(46.8%)，报告目前吸烟(33.8%)，患有糖尿病(19.2%)，并有高度抑郁和焦虑相关症状(38%和16.8%)。2虽然HCHS/SOL可以为不同拉美裔/拉丁裔种族背景的个人的心血管风险的显著差异提供新的流行病学见解，但缺乏非拉美裔比较组限制了研究人员阐明导致心血管发病率和死亡率的种族差异的因素的能力。Rodriguez和他的同事在这一期中的论文3采取了几个重要的步骤，以克服以前对拉美裔/拉丁裔的CV研究的缺点，并朝着回答拉美裔悖论提出的许多问题迈进。在他们的论文中，作者分析了多中心随机临床试验--收缩压干预试验(SPRINT)的基线数据，该试验检查了适当的收缩压目标，以降低50岁以上糖尿病高血压患者的心血管发病率和死亡率。值得注意的是，斯普林特要求西班牙裔/拉丁裔参与者确定他们的种族是波多黎各人、古巴人、墨西哥人或其他拉美裔背景。在美国和波多黎各也进行了诊所招聘。这样做可以让研究人员比较西班牙裔种族(西班牙裔与非西班牙裔)和地理位置的基线特征。基线测量包括血压、身高和体重、空腹血和尿样、心电图、认知功能、一般健康相关生活质量、抑郁症状、日常功能状态、病史、健康行为(如体育活动、吸烟/饮酒)和服药依从性。与之前的研究类似，作者发现，西班牙裔/拉丁裔参与者服用的降压药较少，更有可能出现收缩压升高和血脂谱恶化，以及报告的体力…水平较低
Hypertension is the single most important factor driving the high rates of cardiovascular (CV)-related mortality and healthcare expenditures in the United States (US). Despite the significant burden of hypertension, several decades of research have shown that Hispanics/Latinos, the fastest growing ethnic group in the US, experience lower rates of CV-specific and all-cause mortality relative to non-Hispanic whites. This phenomenon—termed the Hispanic paradox—persists despite significantly poorer CV risk profiles (eg, higher rates of obesity, hypoglycemia, diabetes, and lower rates of physical activity) in Hispanics/Latinos compared with non-Hispanic whites. 1 While many theories have been proposed to support or refute this paradox (ie, salmon bias hypothesis, healthy migrant effect, better social support), many have failed to account for the increasing heterogeneity of the Hispanic/Latino population. Instead, Mexican Americans are most often represented in studies of CV disease, potentially obscuring the true burden of hypertension in the diverse Hispanic/Latino subgroups. For example, recent data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) indicate that Mexican Americans experience the lowest prevalence of hypertension (21.7%) as compared with those of Cuban, Dominican, and Puerto Rican backgrounds who exhibit the highest prevalence (range: 31.5%–32.2%). 2 Similar patterns were seen with blood pressure (BP) control with the poorest rates found in participants younger than 40 years (20% BP control) and Central American and Dominican men (12% and 27%, respectively). Individuals of Puerto Rican backgrounds were also significantly more likely to be obese (46.8%), report currently smoking (33.8%), have diabetes (19.2%), and have high depressive and anxiety-related symptoms (38% and 16.8%) as compared with all other Hispanic/Latino groups. 2 While HCHS/SOL can offer new epidemiologic insights into the significant variation in CV risk across individuals of diverse Hispanic/Latino ethnic backgrounds, the lack of non-Hispanic comparison groups limits researchers’ ability to elucidate the factors driving racial differences in CV morbidity and mortality.The paper by Rodriguez and colleagues3 in this issue takes several important steps to overcome shortcomings of previous CV studies in Hispanics/Latinos and move toward answering the many questions posed by the Hispanic paradox. In their paper, the authors analyze baseline data from the multicenter, randomized clinical trial, Systolic Blood Pressure Intervention Trial (SPRINT), which examined the appropriate targets for systolic BP to reduce CV morbidity and mortality in a diverse sample of diabetic hypertensive patients older than 50 years. Notably, SPRINT asked Hispanic/Latino participants to identify their ethnicity as being of Puerto Rican, Cuban, Mexican, or other Hispanic background. Clinic recruitment was also conducted in the US and Puerto Rico. Doing so allowed researchers to compare baseline characteristics by Hispanic ethnicity (Hispanic vs non-Hispanic) and by geographic location. Baseline measurements included BP, height and weight, fasting blood and urine samples, electrocardiogram, cognitive function, general health-related quality of life, depressive symptoms, daily functional status, medical history, health behaviors (eg, physical activity, smoking/alcohol use), and medication adherence. Similar to previous research, the authors found that Hispanic/Latino participants were prescribed fewer antihypertensive medications and more likely to have elevated systolic BP and worse lipid profiles as well as report lower levels of physical …