The Research Brief is a short take about interesting academic work.
The big idea
Latinos may have higher rates of heart disease than previously thought, refuting a well-accepted idea known as the “Latino paradox,” according to a new study that I was involved in.
The crux of the Latino paradox is as follows: A broad body of research shows that Latinos have higher rates of diabetes, obesity and uncontrolled blood pressure and cholesterol levels than non-Hispanic white people. So naturally, it would follow that Latino people should also have higher levels of cardiovascular disease.
But for the past 30 years, a wide body of studies has found the opposite: Despite greater risk factors for heart disease, Latinos have lower mortality from rates of heart disease than non-Latino people.
We found, however, that both Latino men and women have significantly higher rates of heart disease than non-Hispanic whites. In fact, for men we found rates of heart disease that were even slightly higher than among Black people, a group with the highest rates of heart disease. We found that 9.2% of Latinos had a diagnosis of heart disease, compared with 8.1% among Black people and 7.6% among non-Hispanic white men.
To do the analysis, we used data from the All of Us research program, which seeks to enroll at least 1 million people from diverse backgrounds over the next few years. We examined medical record data from the more than 200,000 people who have already signed up for the program, including over 40,000 Latinos.
Going into the study, we assumed that we would find evidence in support of the Latino paradox. Prior data on the paradox was based mostly on mortality records or self-reporting, both of which have inherent limitations. For example, without an autopsy, it is often hard to know for certain what led to a person’s death. People also may not be aware that they had heart disease, especially if they have not seen a doctor in a long time.
Instead, our work looked at medical records and examined diagnoses of heart disease as determined by a physician during health care visits. We think this is a novel approach, as it uses more robust data to examine this issue.
Why it matters
The widely accepted “Latino paradox” has been studied extensively. And until now, most studies have supported it, though none have found a concrete explanation for it. Medical and public health students are often taught about it as an unexplained phenomenon. But our study, using the largest research cohort of Latinos in the United States, seems to refute the paradox.
The implications are critical because they suggest that like all groups, Latinos still need to take care of themselves by eating healthily, exercising regularly, watching their weight, avoiding smoking and getting regular check-ups. Those with diabetes, hypertension or cholesterol, need to make sure those conditions are well-controlled.
These seemingly straightforward messages are the ones that doctors have been telling all of their patients for decades. Yet this study makes it clear that Latinos don’t get a free pass when it comes to heart disease and that they also need to follow health guidelines. And our study highlights the ongoing need for culturally tailored cardiovascular health programs for the Latino community.
What is still unknown
Although our study analyzed data from the largest existing cohort of Latinos, we do not think ours is the definitive word on the topic. More research is needed, and we need to continue to think creatively about how to get at these questions. It is also important to keep in mind that Latino populations are not homogeneous. Latinos come from many different parts of Latin America, where diets, customs and lifestyles are all unique.
For that reason, our team is interested in looking at health data focused on Latino subgroups, as well as comparing U.S.-born Latinos with immigrants. We also hope to examine the Latino paradox when it comes to other conditions such as cancer, which research has also shown occurs less frequently among Latinos than other groups. That is another paradox that we need to reexamine.
Olveen Carrasquillo receives funding from National Institutes of Health (NIH) and Patient Centered Outcomes Research Institute (PCORI).