Coronary Heart Disease Risk in Cuban Americans with and without Type 2 Diabetes

摘要

Background and AimsCoronary heart disease can be greatly reduced by lifestyle changes. The death rate from diabetes for Cuban Americans is more than twice that for non-Hispanic Whites; yet, recent studies of risk factors and health outcomes for Cuban Americans are lacking. The purpose of this study was to assess dietary, biometric and clinical predictors of coronary heart disease (CHD) in Cuban Americans by diabetes status and gender. Secondary objectives were to assess predictors of the incidence of stroke, angina and coronary or peripheral artery disease (CAD/PAD). Methods and ResultsCuban American adults: N = 367; 190 with type 2 diabetes (72 males, 118 females) and 177 (59 males, 118 females) without diabetes were recruited from a randomly generated mailing list from Broward and Miami-Dade counties, Florida, USA. Significant differences in predictors of CHD risk were found by gender and diabetes status. As expected, we found a positive association between diabetes and stroke; however, female participants were less likely to report having stable angina than male participants. The probable CAD/PAD was predicted by SBP and age; whereas, probable unstable angina was associated with family history of coronary heart disease, being male and smoking.ConclusionsWe found gender and diabetes status delineated risk factor patterns among a Cuban American sample. These findings suggest the need to revise health policies to promote early screening and aggressive treatment of CHD risk factors for both men and women. Prospective studies of CHD risk factors and mortality for Cuban Americans are warranted. Introduction Coronary heart disease (CHD) can be greatly decreased by lifestyle changes in diet, physical activity and tobacco usage. Despite public health campaigns, promoting healthy lifestyle modifications, CHD remains the leading cause of death in the United States for both men and women; in 2005 the mortality rate due to CHD was 211 per 10,000 deaths [1,2]. It has been well-established that individuals with diabetes are at greater risk for CHD than those without diabetes [2-6]. Diabetes is considered a risk factor for CHD and CVD by the Center for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) [2, 6-7]. An estimated 23.6 million people (2007) in the United States (7.8% of the population) have diabetes [8]. The prevalence, incidence and mortality from all forms of CVD are 2-8 times higher for persons with than for persons without diabetes [9]. More specifically, the risk of death from coronary heart disease (CHD) for persons with type 2 diabetes is 2 to 4 times higher in comparison to persons without diabetes [10]. The vast majority of diabetes cases (90?95%) constitute type 2 diabetes [8]. Type 2 diabetes has been shown to be prevented by lifestyle changes in several large epidemiological studies across continents [6,9,11]. Cuban Americans are one of three major groups of Hispanic/Latino origin and represent 4% of the Hispanics in the United States [12]. Yet, Cuban Americans have been given little attention in recent health studies; instead, the majority of research has been conducted on Mexican and Puerto Rican Americans. Since each ethnic group has a unique social history, cultural identity, set of health behaviors and genetic predispositions to diseases, findings from one Hispanic subgroup are not applicable to others. The last major study conducted among Hispanic subgroups was the Hispanic Health and Nutrition Examination Survey (HHANES) which was conducted during 1982?1984 [3]. Analyses of the HHANES data indicated a higher prevalence of overweight, cigarette smoking and type 2 diabetes in Cuban Americans as compared to other Hispanic ethnicities [4]. Trends in socioeconomic status and lifestyle behaviors may have changed from when HHANES was conducted (over 25 year ago). More recently, but still over 10 years ago, the Miami Community Health Study [13] investigated three ethnicities (African Amer