Abstract 15935: The Hispanic Paradox of Cardiovascular Mortality: A Systematic Review and Meta-Analysis
Background: Hispanics, the largest and the fastest growing minority in the U.S, have a higher prevalence of several cardiovascular (CV) risk factors like obesity, type 2 diabetes mellitus and atherogenic dyslipidemia than Non-Hispanic Whites (NHW). However, some studies have shown a paradoxic lower rate of CV events among Hispanics when compared to NHW.
Methods: We performed a systematic review and a meta-analysis of cohort studies comparing CV mortality between Hispanic and NHW populations in the U.S. We searched the EMBASE, MEDLINE, Web of Science, and Scopus databases, covering from 1950 through February 2011, using terms related to Hispanic ethnicity, CV diseases and cohort studies. We pooled risk estimates using a random effects model using the most adjusted model of each publication.
Results: We found 341 publications of which 19 fulfilled the inclusion criteria. Data represent 22,341,193 Hispanics and 88,825,172 NHW, collected from 1950 to 2006. Twelve of the studies stratified the analysis by gender, and 2 studies stratified people by place of birth, like U.S-born, Mexican-born, Central/South American-born, etc. There was a statistically significant association between Hispanic ethnicity and lower CV mortality (OR 0.69; 95% CI, 0.59-0.81, p <0.001) and all cause mortality (0.74; 95% CI, 0.65-0.84; p<0.001). Study level results are shown in the Figure. The strength of association did not differ by sex. In meta-regression, there was no correlation between the strength of the association and the length of follow up, place of birth or mean age of patients (P>0.05 for all analyses).
Conclusion: These results confirm the existence of a Hispanic Paradox regarding CV mortality. Further study is needed to identify the mechanisms mediating this protective cardiovascular effect in Hispanics.
- © 2011 by American Heart Association, Inc.