Prevalence and Trends in Cardiovascular Risk Factors Among Middle Aged Persons from Five Race and Ethnic Groups in the United States: A Longitudinal Analysis of Two Cohort Studies

ImportanceIt is well established that people of South Asian background have a high burden of atherosclerotic cardiovascular disease (ASCVD). However, few studies have comprehensively examined if South Asian adults in the United States (US) develop cardiovascular risk factors at younger ages than adults from other race and ethnic groups. ObjectiveTo compare the prevalence and change in ASCVD risk factors across age strata by race and ethnic group. DesignWe combined data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) and the Multi-Ethnic Study of Atherosclerosis (MESA) cohort studies. Longitudinal data from all eligible participants at all available exam visits were used to estimate the prevalence of risk factors at ages 45 and 55 years for each race and ethnic group. SettingMulticenter longitudinal cohort study in 7 field centers across the U.S. ParticipantsThe baseline study sample included individuals free of clinical ASCVD; 554 South Asians, 796 White, 588 Black, 517 Hispanic/Latino, and 245 Chinese adults aged 45-55 years were included. ExposuresSelf-identified race (Black, Chinese, South Asian, or White) or ethnic group (Hispanic/Latino). Main Outcome(s) and Measure(s)Prevalence of clinical (prediabetes & diabetes, hypertension, dyslipidemia, BMI) and behavioral (diet quality, alcohol use, exercise) ASCVD risk factors at age 45 and age 55. ResultsAt age 45, South Asian men and women had the highest prevalence of pre-diabetes and diabetes and higher prevalence of hypertension compared to White, Chinese, and Hispanic/Latino men and women. South Asian men had a higher prevalence of dyslipidemia than White, Chinese, and Black men, and South Asian women had a higher prevalence than Chinese and Black women. All groups had worse diet quality than South Asian men and women at age 45, and most also had higher rates of alcohol use. Conclusions and RelevanceWe observed significant differences in the prevalence of risk factors for South Asian adults compared to adults from other U.S. race and ethnic groups at age 45 years. Understanding trends and disparities in cardiovascular risk and protective factors across the life course can help equitably improve prevention and treatment strategies for US populations. Key PointsO_ST_ABSQuestionC_ST_ABSDo South Asian adults have a higher burden of cardiovascular risk factors at age 45 years compared adults from other race and ethnic groups? FindingsIn this study of 2754 adults from two cohort studies, the prevalence of prediabetes and diabetes at age 45 years was higher among South Asians than in Black, Chinese, Hispanic and White adults; hypertension prevalence was higher among South Asians than all groups except Black adults. MeaningSouth Asian adults have a higher prevalence of several clinical cardiovascular risk factors at a younger age.