The American Heart Association has issued a scientific statement regarding type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD) in Asian American adults, as published in Circulation.
The statement summarized current literature on the demographics and biological and social mechanisms that are associated with T2D and ASCVD, addressed acculturation with appropriate approaches in disease prevention and management, and focused on future research directions and clinical strategies that can help lower the incidence of T2D and ASCVD in Asian American adult patients.
Asian American subgroups have marked heterogeneity of diabetes prevalence, with a 2016 Kaiser Permanente Northern California study finding an adjusted diabetes prevalence that ranged from 15.6% in a Chinese population to 34.5% in Native Hawaiian/Pacific Islander adults. Data from Kaiser Permanente Northern California from 2006 to 2016 found a 2.04-fold increased rate of incident coronary artery disease in South Asian vs non-Hispanic White adults.
Other research has shown an increased incidence of self-reported hypertension in South Asian immigrants compared with non-Hispanic White adults, as well as a higher prevalence of high cholesterol among Asian immigrants who were born in Southeast Asia. A number of studies of non-European ancestry cohorts have found genetic variants that may be unique to ASCVD risk in certain Asian ancestries.
Studies involving Asian American immigrants have shown that risk factors for ASCVD, including diet and physical activity, vary based on acculturation. Greater US acculturation has been linked to an increased risk for ASCVD. In addition, more acculturated Asian American adults are likely to perform more moderate to vigorous physical activity compared with less acculturated Asian American adults.
Acculturation also affects smoking behaviors in Asian immigrants, with evidence that the magnitude of influence may be greater in women and adolescents than in men. Smoking prevalence varies based on sociodemographic factors among Asian immigrants, with increased rates found in Vietnamese and Korean immigrants who are men.
Asian dietary patterns have a number of benefits, including the consumption of unsweetened tea, fresh fruits and vegetables, and soybeans and plant-based products. However, the negative aspects of Asian diets include high refined grains such as white rice and noodles, high sodium intake, use of organ meats, and cooking oils that are high in saturated fat.
“Because dietary practices are related to dietary acculturation, the ability to assess the level of dietary acculturation is vital to provide the appropriate nutrition education and intervention in this population,” stated the AHA writing group.
A heart-healthy dietary pattern should emphasize a diet that is characterized by an abundance of fruits and vegetables, whole grains, lean or vegetable protein (plants, seafood, low-fat or fat-free dairy products, and, if meat or poultry is desired, lean cuts and unprocessed forms), liquid plant oils, and minimally processed foods, according to the statement.
The researchers noted a lack of pharmacologic intervention data for Asian American adults and that it is not fully known if there are intra-ethnicity differences among Asian American subgroups.
“Because of the high incidence and prevalence of T2D in Asian American adults, there is an urgent need for specific physiological studies and long-term, prospective, randomized controlled trials that include large Asian American subgroup patient samples to demonstrate their safety and efficacy,” stated the writing committee. “Future studies of ASCVD risk in Asian American adults also need to be adequately powered, to incorporate multiple Asian ancestries, and to include multigenerational cohorts.”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Kwan TW, Wong SS, Hong Y, et al. Epidemiology of diabetes and atherosclerotic cardiovascular disease among Asian American adults: implications, management, and future directions: a scientific statement from the American Heart Association. Circulation. Published online May 8, 2023. doi: 10.1161/CIR.0000000000001145