Although the Asian American population is the fastest growing racial group in the United States, having more than doubled since 2000, data are limited on the distribution of risk factors for cardiovascular disease among ethnic subgroups. A recent research letter in the Annals of Internal Medicine found significant differences in age-standardized cardiovascular mortality between 2018 to 2023, with Filipino males having the highest rates, followed by Indian males and Filipino females. Notably, Indian American individuals had high mortality associated with heart disease and diabetes, whereas Chinese American individuals had higher mortality from stroke and hypertension-related conditions.
A 2024 American Family Physician editorial by Drs. Asha Shajahan and Saavia Girgla highlighted cardiovascular disparities in people of South Asian ancestry. Earlier risk calculators (Framingham, Pooled Cohort Equations) underestimate cardiovascular risk in South Asians; it is unclear whether the estimates from the newer PREVENT equations have greater accuracy in this population. The authors recommended routinely asking about family histories of premature heart disease and providing culturally informed lifestyle counseling to South Asian patients with insulin resistance (including type 2 diabetes) and metabolic syndrome.
Some national and international studies support lower body mass index (BMI) thresholds for overweight and obesity in Asian American patients. The World Health Organization identified BMIs of 23 and 27.5 kg/m2 as public health action points, corresponding with BMIs of 25 and 30 kg/m2 in non-Asian populations. However, pooling data from all Asian individuals can obscure concerning trends in subpopulations. An analysis of 2012-2023 data from Kaiser Permanente Northern California found that adults 30 to 49 years of age identifying as Native Hawaiian and other Pacific Islander had the highest overall prevalence of obesity; rapid temporal increases in high BMI (>27.5 kg/m2) were also seen among Filipino and other Southeast Asian populations. Oral semaglutide was effective in reducing body weight in a 68-week randomized trial conducted in Japan and Korea (-14.3% change in body weight in the semaglutide group vs -1.3% in the placebo group).
In 2024, the American Heart Association published a scientific statement on the social determinants of cardiovascular health in the Asian American population. Key upstream determinants include “socioeconomic position, immigration and nativity, social and physical environments, food and nutrition access, and health system-level factors,” all potentially modified by interpersonal discrimination and structural racism. The American Heart Association called on the federal government to collect disaggregated data on cardiovascular risk factors and health outcomes in self-identified Asian subgroups and to support research on community-level determinants of poor cardiovascular health to inform primary prevention strategies.
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This post first appeared on the AFP Community Blog.
