By AMERICAN HEART ASSOCIATION NEWS
Ramona Santana signed up right away when a woman came to her door to recruit her for a study about the health of U.S. Hispanics and Latinos.
The 63-year-old has Type 2 diabetes and hopes researchers find a cure.
“Almost everyone [I know] has diabetes,” said Santana, a retired factory worker who lives in the Bronx, New York. “We should at least allow that they search our immune system thoroughly so that they can find a cure for that disease, because it is very hard.”
Santana takes pride in being part of the study. “Improving quality of health is improving the quality of life,” said Santana, a native of the Dominican Republic who moved to the United States 41 years ago. Her 80-year-old husband Miguel Santana also participates in the project, called the Hispanic Community Health Study/Study of Latinos, or HCHS/SOL.
For nearly a decade, dozens of cardiovascular researchers have benefited from health data provided by the Santanas and more than 16,000 other adults recruited for the National Institutes of Health-funded research project.
Investigators sought participants of Mexican, Cuban, Puerto Rican, Dominican, South American and Central American heritage for what is the first long-term study to look exclusively at the health of the largest ethnic group in the United States. Nearly 80 percent of the participants, who were recruited in the Bronx, Chicago, San Diego and the Miami area, are immigrants from Latin America.
Researchers at health centers in those cities are in the midst of collecting follow-up information about issues such as diabetes, high blood pressure, heart attacks, surgeries, diet, exercise habits, income and education level.
For scientists who study cardiovascular disease and its risk factors, the information has been a boon.
It has allowed them to better understand how Hispanics of different ethnicities are affected by problems that can lead to heart disease, the second-leading cause of death among U.S. Hispanics, and stroke, the fourth-leading cause of death among them. The project has also allowed researchers to compare the health of Hispanic immigrants with U.S.-born Hispanics.
Most compelling have been the findings for diabetes and obesity, two of the leading risk factors for heart disease and stroke.
Statistics from the Centers for Disease Control and Prevention show Hispanics are more likely than whites to have diabetes: 12 percent of Hispanics are diabetic compared with 8 percent of whites. But the rates among some Hispanic ethnic groups appear to be much higher, based on studies using data from HCHS/SOL.
Diabetes researcher Neil Schneiderman, Ph.D., the lead investigator at the HCHS/SOL Miami site, recently led a study that found adults of South American heritage have the lowest rate of diabetes. Only about 10 percent of them have diabetes compared with about 18 percent of persons of Mexican, Puerto Rican or Dominican background.
The gap is on par with the prevalence difference between white and black Americans. Diabetes is almost twice as common among blacks compared with whites, CDC data show.
“We have the same set of differences, same magnitude between one group of Hispanics and another,” said Schneiderman, a professor at the University of Miami’s College of Arts and Sciences.
Also of concern is that many Hispanics are at risk for Type 2 diabetes, said Martha L. Daviglus, M.D., Ph.D., who is the principal investigator at the HCHS/SOL field center in Chicago. Daviglus co-authored a 2014 report from the American Heart Association that was the first to describe the burden of heart disease and stroke among U.S. Hispanics.
Half of Hispanics are at risk for Type 2 diabetes and the age at diagnosis is on average six years younger than for whites, according to the CDC. That is “shocking,” Daviglus said, because the Hispanic population overall is younger than blacks and whites, according to U.S. Census data.
“What’s going to happen in the future?” said Daviglus, a professor of medicine at the University of Illinois at Chicago and director of the university’s Institute for Minority Health Research. “We are concerned that as the Hispanic/Latino population ages, it will experience an increasing burden of heart disease.”
The obesity epidemic in the United States appears to be disproportionately affecting Hispanics, who are more likely to be obese than whites. Researchers have known that statistic for a while, but what has surprised them from the HCHS/SOL data is the “very high proportion” of Hispanics with extreme obesity.
Some research has shown that about 9 percent of Hispanic women in their 20s and 30s are severely obese, said Robert C. Kaplan, Ph.D., who leads the Bronx collection center.
“Our population study almost suggests an entirely new problem,” said Kaplan, an epidemiology professor at the Albert Einstein College of Medicine. “Not just overweight, which might be amenable to improving your diet or becoming a little more physically active. But people who have such severe obesity that they may require surgical interventions.”
A study published last year using data from HCHS/SOL found obesity is most common among Puerto Ricans and least common among South Americans. Puerto Ricans were also nearly twice as likely to be severely obese.
Kaplan pointed out that this is the first time researchers will be able to track the long-term health of Hispanics who are obese.
The AHA is currently funding at least three studies using data from HCHS/SOL participants. The projects total at least $3 million. One study is looking at why some medications increase the risk for irregular heartbeats, while the others examine sedentary behavior and how to reduce sitting time among Latinas.
The main message is that all major cardiovascular risk factors are preventable, Daviglus said. And the findings from studies using HCHS/SOL data can be used to educate patients and inform public policy initiatives targeted to different Hispanic ethnic groups to help them “make better choices for their own health and the health of their family,” she said.
Jaime Melian signed up for the research project after his mother read about it in a newspaper. He wanted to be part of something that could help improve the health of Hispanics — and his own health. The 54-year-old from Hialeah, Florida, is obese.
It took a few years after his first visit to the HCHS/SOL research center to change his habits, but he now exercises regularly, eats lots of fruits and vegetables and has cut out fried foods and soda. He has lost about 10 pounds.
“Going to the SOL study has helped me so much to understand and comprehend what it is to live a good, healthy life,” Melian said.
But it’s not just an education for the patients.
Gregory Talavera, M.D., the principal investigator at the research site in San Diego, said there has been a slow but growing recognition among healthcare providers that Hispanics are from diverse backgrounds and that it’s a mistake to stereotype.
“Among my clinical colleagues, they are starting to understand they need to go beyond the checkbox of Latino and ask this person where did they grow up and what their cultural preferences [are],” said Talavera, a physician and a professor of health promotion and behavioral science at San Diego State University.
In the Bronx, Santana is taking better care of her health. She eats more salads now, has stopped eating beef and pork and drinks more water. She’s also exercising more.
“My life changed,” she said.
Photos courtesy of Albert Einstein College of Medicine and Jaime Melian