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Diabetes, obesity, and inactivity can spell dangerous consequences for Hispanic women sooner than for their non-Hispanic white counterparts. Their risk of cardiovascular disease is similar to that of Caucasians about a decade older, according to research presented at an American Heart Association (AHA) meeting.
"There is likely a large amount of disease in this population that we, as a health care community, have not begun to recognize and may not be treating appropriately," lead author John C. Teeters, MD, a cardiology fellow at University of Rochester Medical Center in New York, tells DOC News. Teeters presented the findings during a poster session at AHA's 47th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, held Feb. 28–March 3 in Orlando, Fla.
Because Hispanics are poorly represented in cardiac studies, and to close the gap in the obvious disparity, "we need to step outside of our offices and hospitals to educate and motivate these patients and improve our own understanding of the diseases and issues they face," Teeters says.
Prevention and identification of cardiometabolic disease should begin in Hispanic women as early as age 20 or 30, the authors advise. But in doing so, practitioners need to be culturally sensitive as they suggest incorporating dietary changes and physical activity into the daily routines of Hispanics—the fastest-growing ethnic group in the U.S.
In their study, Teeters and colleagues offered free health screenings at churches, community centers, and outpatient clinics catering to a Hispanic population. They did not include men in their analysis because so few men came to the screenings.
To evaluate cardiac risk, the researchers took medical histories and measured waist circumference, activity level, weight, height, blood pressure, and glucose and cholesterol levels. For comparison purposes, they collected the same data in a group of Caucasian women. The researchers studied 79 Hispanic and 91 Caucasian adult women, with an average age of 53 years and 63 years, respectively.
They found that the Hispanic participants' prehypertension rate was significantly higher than that of the Caucasian women (32% compared with 19%). The Hispanic women's activity levels were significantly lower, and they had a slightly higher rate of metabolic syndrome (50% compared with 45%). Metabolic syndrome is a cluster of signs and symptoms—including a large waist size, hypertension, insulin resistance, and dyslipidemia—that significantly increases the risk of developing diabetes or experiencing a cardiovascular event such as heart attack or stroke.
"Hispanic women appear to accumulate coronary risks at a younger age—in our study, they were almost a decade younger," says co-author Gladys P. Velarde, MD, an associate professor of medicine and director of the Strong Women's Heart Program at University of Rochester. "This is clearly supported by other epidemiological studies where obesity, inactivity, and diabetes are much higher in younger Hispanic women, mostly Mexican-Americans."
Exposure to a cluster of risks for a longer time causes concern. "This is what we call the `tsunami effect,'" Velarde says. "We have to stop that massive wave of problems."
EARLY, APPROPRIATE INTERVENTION
Hispanic women should address risk factors at a young age, given that even borderline-high glucose or blood pressure can be a recipe for disaster, Velarde says. "They need to act early. They need to be educated about what their numbers—cholesterol, blood pressure, glucose, weight, waist circumference, etcetera—should be," she adds. "This means that providers have to assume a more aggressive role as educators. That is not always easy in our fast-paced environment, but is desperately needed."
Various socioeconomic factors influence the lack of activity among Hispanic women, including entrenched cultural proscriptions such as "sports are for men [and] a woman cannot play soccer," Velarde explains. Suboptimal housing, lack of open spaces, and fear of being outside in unsafe neighborhoods can perpetuate a cycle of sedentary behavior.
Keeping barriers to care and other cultural aspects in mind, health providers can help slow deterioration in cardiac and overall health. One way is to emphasize clearly the impact of exercise in reducing the risk of heart attack and stroke.
"Sometimes we need to kind of wake [patients] up," says Vincent Bufalino, MD, past president of AHA's Greater Midwest Affiliate and CEO of Midwest Heart Specialists, a practice of 55 cardiologists in Chicago's western suburbs. "If you tell someone in their 40s that they're at risk to have a heart attack, it tends to get their attention.
"We try to get folks to find an opportunity to add exercise into their lifestyle—whether it's walking to their jobs or walking while shopping or beginning a walking program in [their] neighborhood," Bufalino continues, noting that some women feel safer walking outside in groups than alone.
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REALISTIC ADVICE
The key is for providers to make practical suggestions such as recommending that their patients walk in shopping malls or acquire an inexpensive piece of workout equipment for home use. Advise patients who become preoccupied with family and other obligations after dinner to try fitting exercise into morning routines, Bufalino adds.
Eating habits that stress moderation—as opposed to eliminating staple ethnic foods such as fried beans and rice—tend to be more realistic and easier to implement. Clinicians may learn tips from a patient like Andrea Guzman, a 63-year-old homemaker from Puerto Rico.
"I am constantly watching my diet and never miss a doctor's appointment or physicals," Guzman says. "I do not add any salt to my foods. I also limit my rice intake by having it about two times per week only. As far as the fried foods, I tend to stay away from them either by boiling my meats or baking. I eat a lot of fresh fruit and vegetables."
Guzman says she has been following these principles for about 5 years, hoping that a family history of cardiovascular ailments won't sap her strength. Her father died of heart problems. An older brother suffered a fatal heart attack a couple of years ago. Another brother, who is 52, recently received a diagnosis of heart disease.
Severe asthma prevents Guzman from going to the gym or walking for extended
periods of time, and she tends to fatigue easily. But she manages to remain
active with her seven grandchildren. "I play baseball. I run after them
all day long. I swim with them," she says. "Just a little bit of
everything." 
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