Comparable risk for atherosclerotic cardiovascular disease (CVD), mortality, and subclinical coronary atherosclerosis have been observed among highly educated non-Hispanic white and Hispanic individuals, according to a study recently published in JAMA Cardiology. These finding suggest that Hispanic populations with high educational attainment may not be included in the Hispanic paradox.
This retrospective cohort analysis analyzed the results of 43,736 non-Hispanic white and 1351 Hispanic participants from the Cooper Center Longitudinal Study, aged 20 to 80 years and with a body mass index from 18.5 to 50.
Measurements were collected between 1972 and 2017 and included cardiorespiratory fitness, measured with a maximal treadmill exercise, and significant metabolic risk factors. Differences between visits were recorded for those visiting multiple times. Pooled cohort equation algorithms were used to approximate individual 10-year risks for atherosclerotic CVD among the participants.
Regression models were used to perform adjustments for education level, year of exam, and age. The Kaplan-Meier method was used to analyze all-cause mortality. Coronary artery calcium was compared between participants after matching for age.
There was no significant difference in level of education between white and Hispanic men (P =.507) or women (P =.08). Metabolic syndrome was more common among Hispanic versus white men (30.6% vs 26.3%) and women (13.1% vs 10.8%). Hispanic participants also showed greater body mass index (0.16 vs 0.09), waist size (0.40 vs 0.26 cm), and levels of triglycerides (1.16 vs 0.36 mg/dL) and glucose (0.25 vs 0.02 mg/dL) than non-Hispanic white participants.
Hispanic women showed higher rates of diabetes (odds ratio [OR], 2.07; 95% CI, 1.25-3.43) and metabolic syndrome (OR, 1.51; 95% CI, 1.16-1.96).
Both women and men who visited ≥2 times showed worsening cardiovascular risk factors. Non-Hispanic white women showed decreased fitness (P <.001). The 10-year risk for atherosclerotic CVD did not vary by ethnicity. Cardiometabolic measures also worsened comparably between groups, and coronary artery calcium did not differ significantly. The mean follow-up was 12.9±7.5 years, during which all-cause mortality was similar between the groups.
Limitations to this study include a homogenous sample that may reduce the generalizability of the model, a small Hispanic-white sample ratio, an inability to capture certain characteristics such as language, and a reliance on education to indicate socioeconomic status.
The study researchers conclude that “Hispanic and [non-Hispanic white] men and women with high educational attainment had similar [atherosclerotic CVD] risk, subclinical coronary atherosclerosis, and mortality during follow-up. These findings do not support the Hispanic paradox in a highly educated Hispanic population.”
Rodriguez F, Leonard D, DeFina L, et al. Association of educational attainment and cardiovascular risk in Hispanic individuals: findings from the Cooper Center longitudinal study [published online December 19, 2018]. JAMA Cardiol. doi: 10.1001/jamacardio.2018.4294