Hispanics and CVD: Country of Origin Matters

Ileana L. Piña, MD, MPH


September 22, 2020

This transcript has been edited for clarity.

Hi there. I'm Ileana Piña, professor of medicine at Wayne State, and this is my blog. There is so much interest in racial and ethnic differences in heart disease, particularly with what is going on right now in the country and the fact that it seems like African Americans and Hispanics are at greater risk for COVID-19. I thought I would share with you [my recent presentation from] the American Society for Preventive Cardiology (ASPC) where I was asked to talk about the risk factors of Hispanics.

I started out by giving a geography lesson because the words "Latino" and "Hispanics" get used interchangeably. I think we Hispanics prefer the word "Hispanic" because it really encompasses Central and South America. Spain, the Caribbean, and Mexico are all Hispanic. But when you see all those different geographical areas, I'm sure you know that the histories of these countries are all different. The genetics are very different, and the migration patterns into the United States have also been very different.

We live with this mantle of the Hispanic paradox. In other words, Hispanics may have an equal amount of risk factors as, say, the non-Hispanic population or even the Caucasian population, but yet they have better outcomes. They have lower mortality and fewer hospitalizations. What I wanted to focus on in my talk was where are the Hispanics and what has changed in the landscape in the United States in the past 20 years.

The CDC has free maps on its website which you can download to see the migratory patterns of change — even within the United States. Early on there was a concentration of Hispanics very close to the Mexican border in states like Arizona and New Mexico, and some in Southern California. Then you have Caribbeans, particularly my people, the Cubans, coming into Florida and a whole other host of Caribbeans going into the Northeast. But in the past 20 years, there has been this incredible migration so that now the populations of the Carolinas have a lot of Hispanics and they come from very many different countries, including Mexico, and that has really changed the landscape.

Why is it so difficult to get data on Hispanics? Because they are not being included in the clinical trials. You have heard me say this before in this blog. It takes a bigger effort to get an investigative site for a trial whose population consists of a lot of Hispanics and where the clinicians and investigators are also Hispanics. Hispanics do like to go to their own neighborhoods and be with our own people. How are we ever going to determine what the true consequences are of drugs or devices if we don't have a population to study it? We have a big effort with the Heart Failure Collaboratory where many of us, including my regulator colleagues, pharma, and device industry, are looking at how we can improve recruitment. Why is this important? Because I think the Hispanic paradox has a lot to do with that population being younger, and we may see a tsunami of cardiovascular disease as that population ages.

For those of you who are interested, look at the Studies of Latinos (SOL) trial. This is the National Institutes of Health equivalent of the Framingham study for Hispanics. It is a very well set up, designed, and executed epidemiologic study of sites in San Diego, Miami, the Bronx, and Chicago. Participants may come in absolutely healthy but develop risk factors through time. We're going to start seeing literature and outcomes on some of these patients who are now getting older because a big portion of the SOL population is turning 60. I want everybody to be aware of this, so that when these patients hit your door, you can understand a little bit better that those risk factors may actually differ by their background, their culture, the place where they or their ancestors came from (where hypertension or diabetes may be more prevalent). They are to be taken in that context, not just in the risk factor alone.

I wanted to give you these thoughts because the ASPC meeting was so excellent and really touched on racial and ethnic differences. This is Ileana Piña, signing off. Thank you for joining me today.

Ileana L. Piña, MD, MPH, is a heart failure and cardiac transplantation expert. She serves as an advisor/consultant to the FDA's Center for Devices and Radiological Health and has been a volunteer for the American Heart Association since 1982. Originally from Havana, Cuba, she is passionate about enrolling more women and minorities in clinical trials. She also enjoys cooking and taking spin classes.

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