From the Journals

Premature death from heart disease hits Asian subgroups hard



Among Asian American subgroups, Asian Indian, Filipino, and Vietnamese populations showed significantly higher premature death rates from ischemic heart disease, compared with other Asian subgroups, based on data from the National Center for Health Statistics for the years 2003 to 2012.

Previous studies have described death rates from cardiovascular disease in Asian subgroups, but premature death in particular has not been well studied, wrote Latha Palaniappan, MD, of the division of primary care and population health at the Stanford (Calif.) University, and her colleagues.

To examine premature mortality from cardiovascular disease in Asian subgroups, the researchers used years of potential life lost (YPLL) to measure premature mortality. “[Years of potential life lost ] compares age at death with average life expectancy to estimate the average time an individual would have lived had he/she not died prematurely from a specific disease,” they explained.

The study population included 354,256 Asian American decedents aged 25 years or older. Of that total, 59,936 died of ischemic heart disease and 28,489 died of cerebrovascular disease.

Overall, Asian men lost 779 years/100,000 people in 2003 and 574 years/100,000 in 2012. However, in 2003, Asian Indian men in particular lost 1,216 years/100,000, more than other Asian male subgroups and non-Hispanic white men.

“Use of race-specific life expectancy revealed greater heterogeneity in YPLL across all Asian subgroups,” the researchers wrote. Similarly, Asian Indian women had the highest years of potential life lost throughout the study period, with a high of 818 years/100,000 people in 2003 and 477 years/100,00 in 2012, compared with 577/100,000 and 426/100,000, respectively, among non-Hispanic white women.

All Asian male subgroups also lost more years of life to cerebrovascular disease, compared with non-Hispanic white men, and women in each Asian subgroup had a higher years of potential life lost, compared with non-Hispanic white women. Filipino men had the highest YPLL values for the period, followed by Vietnamese men, and the patterns were similar for Filipino and Vietnamese women.

Possible explanations for the high rate of premature death from ischemic heart disease in Asian Indians include greater prevalence of risk factors at younger age (including elevated apolipoprotein B100/apolipoprotein A-1 ratios), type 2 diabetes, and cardiometabolic abnormalities in people of normal weight that might go unnoticed in a clinical exam, the researchers said. In the case of cerebrovascular disease, possible risk factors for high years of potential life lost in certain subgroups include hypertension in Filipino populations, limited health literacy about stroke in Vietnamese populations, and high rates of smoking in Vietnamese men.

The study findings were limited by several factors, including the small amount of data on mortality in Asian Americans from census reports, the researchers noted. However, the use of years of potential life lost as a measure of the impact of cardiovascular disease provided a useful model of the impact of cardiovascular disease on life expectancy and total disease burden of cerebrovascular disease on Asian ethnic subgroups, they said.

“Our study also provides evidence that evaluating the Asian population together as one group underestimates the burden of [cerebrovascular disease],” they noted.

The National Institute of Minority Health and Health Disparities Research Project and the National Heart, Lung, and Blood Institute supported the study in part by grants to researchers. The researchers had no financial conflicts to disclose.

SOURCE: Iyer DG et al. J Am Heart Assoc. 2019 Mar 20. doi: 10.1161/JAHA.118.010744.

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