AHA Statement Addresses Gaps in Hispanic CVD Care

Hispanic adults living in the United States bear a disproportionate burden of chronic disease, including CVD, highlighting the urgency to enhance strategies aimed at prevention, improve access to care, and boost participation in clinical research, according to a new scientific statement from the American Heart Association (AHA).

The statement, published recently in Circulation, notes that obesity affects nearly 46% of Hispanic adults, with 44% having hypertension. The rate of diabetes is twice that of white individuals, at more than 15%. Additionally, there is also evidence that certain risk factors, as well as MI and stroke, may present up to 8 years earlier in this population. 

“Many Hispanic patients unfortunately don’t [get] preventive care for many reasons, including access and sociocultural issues,” writing group chair Johanna Contreras, MD, MSc (Mount Sinai Hospital, New York, NY), told TCTMD. “In their home countries, preventive medicine may not be something that people are used to.”

She added that even among her own patients, many are seeing a physician for the first time and only because they are sick. Contreras and the committee say there is an urgent need for culturally relevant prevention efforts, along with proactive education aimed at debunking the long-held “Hispanic paradox,” an old belief that Hispanic ethnicity by itself is associated with lower rates of CVD mortality.

The statement addresses evolving thinking about the paradox as well as about genetics that may predispose to specific risk factors. It also calls attention to the need to diversify risk factor management in patients categorized as “Hispanic,” the largest ethnic minority group in America, noting important differences between those born in the United States and those born elsewhere.

“We are not monolithic,” Contreras said. “For example, people from Puerto Rico are more likely to have high blood pressure and complications of high blood pressure. People [who are] Cuban and Dominican are more likely to have hypercholesterolemia as well as high blood pressure, and they’re also more likely to smoke. Mexican Americans are more likely to have metabolic syndrome and early-onset diabetes.” 

Then there are those who hail from a host of South American countries that have not been studied enough to have evidence-based knowledge about their risk factor profiles. According to the statement, Hispanic adults born in the US have been shown to have a shorter life expectancy and higher death rates compared with foreign-born peers.

Socioeconomic, Language, and Other Barriers

Examinations of diet, sleep, and exercise in Hispanic adults suggest that fewer than 2% meet recommended daily sodium limits, fewer than 10% meet recommendations for healthy fats, one-third report sleeping less than 7 hours per night, and nearly one-third report no moderate-to-vigorous physical activity.

The statement also pays specific attention to the unique constellation of CV risk factors in Hispanic women, noting that a 2023 scientific statement from the AHA highlighted that 71% had at least one CV risk factor, with the highest bur­den seen in women from Puerto Rico and the lowest observed in those from South America.

Contreras and colleagues say CVD patterns in Hispanic adults “reflect the intersection of heritage-specific risk profiles, inequi­ties in care, and broader social and structural determinants.”

The percentage of Hispanics living below the federal poverty level in the US is more than double that of white adults and data show consistent wage disparities between the two groups despite comparable education levels. Then there is the issue of low or limited health literacy, which is estimated at 9% in white adults compared with 40% of the Hispanic population, with an even higher percentage (66%) among older Hispanic adults.

"We need to learn where people come from and what their culture is like if we really want to get through to them," Contreras noted, adding that only about 6% of practicing cardiologists are Hispanic, further limiting the ability of Hispanic patients to connect culturally with the healthcare system in ways that can influence their care-seeking behaviors and decisions. 

Another thing that may help is more use of community health workers, or promo­tores de salud. Interventions involving these workers who speak the same language bringing education and care initiatives to people where they live, socialize, and worship have been shown to help improve physical activity, nu­trition, and smoking cessation. Contreras and colleagues say with nearly one-third of Hispanic adults in the US having limited English proficiency, language-concordant care is critical.

The underrepresentation of Hispanic individuals in research, particularly genomic studies, is another area in which creative outreach is needed to address deep gaps in research. According to Contreras, more transparency is badly needed to recruit patients into studies that could pay out big dividends in terms of identifying novel risk loci and ancestry-specific modifiers of CVD risk, as well as shedding light on biological pathways where social determinants of health, environmental exposures, and cardiometabolic diseases intersect.

“Many times, people are asked to sign a consent form, and they have no idea what that means,” Contreras noted.  ”We are working with some of the local TV channels—Telemundo, Univision—to talk about what that means. With the National Hispanic Medical Association, we’re doing a lot of webinars, going into the communities, to the churches to understand what is needed and how can we educate patients to understand how important [being involved in research] is. I talk to my patients, every one of my patients, [about] what is a clinical trial, what that means, why it is important for them to be there and be part of this process to help other people.”

While many big hurdles exist,  enrolling more Hispanic patients, with their diversity of cultures, languages, and experiences, into research can make a difference, and Contreras is optimistic that putting in the work will pay off. Part of her education style, she added, is to be clear with Hispanic patients that as a group they are presenting at younger ages with devastating diseases that lead to long-term disability, so stressing prevention is key.

The current political climate isn’t helping. “I also have patients that are citizens, but they don’t want to come to the hospital because they are worried that they’re going to get deported,” she added. “It’s [part] of also the culture barrier that we have to talk to people about—we have to communicate with people and policies [are needed] that can change that.”