Irma B. Ancheta

Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations A Scientific Statement From the American Heart Association

Obesity, defined as excess fat (adipose) tissue accumulation that may impair health,1 is a highly prevalent and serious public health problem. Roughly 35.7% of American adults are obese.2 High rates of obesity are not limited to the United States or even to other highly developed countries. The prevalence of obesity in Mexico, for example, is comparable to that in the United States.3 Not surprisingly, rates of obesity-related illnesses including cardiovascular disease (CVD) are rising quickly worldwide. More than 25 million American adults have been diagnosed with diabetes mellitus.4 India is projected to have >100 million diabetic people by the year 2030.5 CVD is the number 1 cause of death worldwide.6 These grim statistics highlight the need for accurate identification of overweight and obese adults who are at high risk for obesity-related illnesses. Accurate identification of such people allows healthcare professionals, policymakers, and others to target prevention and treatment programs to those at the highest risk of morbidity and mortality. Unfortunately, the tools and measures currently available to identify obesity and associated risks are either impractical, inaccurate, or both. For example, the body mass index (BMI) is easy to calculate, and established cutoffs that define overweight (25 kg/m2) and obesity (30 kg/m2) are readily available and well known. The application of such cutoffs to a diverse population, as will be discussed, however, leads to misclassification of a large number of people. Many people with a normal BMI have high levels of adiposity and also are at high risk for obesity-related illness. Others with a high BMI have relatively normal levels of adiposity and are metabolically healthy. The problem of misclassification is especially important for racial and ethnic minorities, who make up nearly 40% of the American population today and will make up more …

Racial/Ethnic Differences in Hypertension Prevalence, Treatment, and Control for Outpatients in Northern California 2010–2012

BACKGROUND Hypertension (HTN) is a known major cardiovascular disease risk factor, but prevalence, treatment, and control of HTN among rapidly growing minority groups such as Asian Americans and Hispanics are unknown largely due to either underrepresentation in epidemiologic studies or aggregation of Asian American subgroups. METHODS A three-year cross-section (2010-2012) of patients from a large ambulatory care setting in northern California was examined in the following subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Mexicans, non-Hispanic Blacks (NHBs), and non-Hispanic Whites (NHWs). We defined HTN as two separate nonemergent office visit blood pressure measurements ≥140/90 mm Hg, physician diagnosis of HTN, or use of antihypertensive medications. RESULTS A total of 208,985 patients were included in the study. Age-adjusted HTN prevalence ranged from 30.0% in Chinese women to 59.9% in Filipino men. Most minority subgroups had lower or similar odds of having HTN compared with NHWs, except for Filipinos and NHBs whose odds were significantly higher after adjusting for patient demographic and clinical characteristics. Asian Americans and NHBs were more likely to be treated for HTN compared with NHWs. Achievement of blood pressure control was lower among Filipino women (odds ratio = 0.82, 99% confidence interval 0.70-0.96) and NHB men (odds ratio = 0.73, 99% confidence interval 0.58-0.91), compared with NHW women and men. CONCLUSIONS Substantial racial/ethnic variation in HTN prevalence, treatment, and control was found in our study population. Filipino and NHB women and men are at especially high risk for HTN and may have more difficulty in achieving adequate blood pressure control.

The impact of B-type natriuretic peptide, New York Heart Association classification and depression on quality of life in nonhospitalized heart failure patients.

Healthcare providers should be concerned with improving the quality of life (QOL) of patients with heart failure (HF) because disease-specific QOL is linked to disease progression. The present study investigated the significance of elevated b-type natriuretic peptide (BNP), NYHA classification and depression to HF-related QOL to develop better management strategies. Outpatient subjects with left ventricular systolic dysfunction (n=108; mean age=64.9+/-12) completed the self-administered Minnesota Living with Heart Failure questionnaire and the Center for Epidemiologic Studies Depression Scale. Functional status was measured using the New York Heart Association Classification (NYHA) and BNP concentrations were measured in plasma samples. Multiregression analysis determined that plasma BNP levels did not contribute significantly to the total QOL score while depression (r=0.63, t ratio=7.43, P<.0001) and NHYA class (r=0.47, t ratio=3.31, P<.001) were significant contributors. NYHA III subjects exhibited worse depression scores (II 15+/-7 and III: 22+/-10, P<.001) and elevated plasma BNP (II: 2.0+/-0.5 and III: 2.4+/-0.6, P<.001). Low-cost psychological assessments are recommended to evaluate depression and suggest that those HF patients with NYHA III be closely monitored for depression and reduced QOL.

Comparison of body mass index, waist circumference, and waist to height ratio in the prediction of hypertension and diabetes mellitus: Filipino-American women cardiovascular study

The relative ability of three obesity indices to predict hypertension (HTN) and diabetes (DM) and the validity of using Asian-specific thresholds of these indices were examined in Filipino-American women (FAW). Filipino-American women (n = 382), 40–65 years of age were screened for hypertension (HTN) and diabetes (DM) in four major US cities. Body mass index (BMI), waist circumference (WC) and waist circumference to height ratio (WHtR) were measured. ROC analyses determined that the three obesity measurements were similar in predicting HTN and DM (AUC: 0.6–0.7). The universal WC threshold of ≥ 35 in. missed 13% of the hypertensive patients and 12% of the diabetic patients. The Asian WC threshold of ≥ 31.5 in. increased detection of HTN and DM but with a high rate of false positives. The traditional BMI ≥ 25 kg/m2 threshold missed 35% of those with hypertension and 24% of those with diabetes. The Asian BMI threshold improved detection but resulted in a high rate of false positives. The suggested WHtR cut-off of ≥ 0.5 missed only 1% of those with HTN and 0% of those with DM. The three obesity measurements had similar but modest ability to predict HTN and DM in FAW. Using Asian-specific thresholds increased accuracy but with a high rate of false positives. Whether FAW, especially at older ages, should be encouraged to reach these lower thresholds needs further investigation because of the high false positive rates.

The Association between KIF6 Single Nucleotide Polymorphism rs20455 and Serum Lipids in Filipino-American Women

The Trp719Arg allele of KIF6 rs20455, a putative risk factor for CHD especially in those with elevated low-density lipoprotein cholesterol (LDL-C), was investigated in Filipino-American women (FAW, n = 235) participating in health screenings in four cities. The rs20455 genotype of each subject was determined by a multiplex assay using a Luminex-OLA procedure. The risk allele Trp719Arg was present in 77% of the subjects. The genotype distribution was 23% Trp/Trp, 51% Arg/Trp, and 26% Arg/Arg. Genotype did not predict the presence of CHD risk factors. Moreover, LDL-C, HDL-C, and triglycerides mean values did not vary as a function of genotype. However, those with the Arg/Arg genotype on statin medication exhibited a significantly higher mean triglycerides level (P < 0.01). Approximately 60% of participants regardless of genotype exhibited LDL-C levels ≥100 mg/dL but were not taking medication. Approximately 43% of those with the Trp719Arg risk allele on statins exhibited elevated LDL-C levels. Our study suggests that the Trp719Arg allele of KIF 6 rs20455 is common among Filipino-American women; thus, even with borderline LDL-C levels would benefit from statin treatment. Secondly, many participants did not exhibit guideline recommended LDL-C levels including many who were on statin drugs.

Health disparities in genomics and genetics.

Disparities or inequities in health refer to sociodemographic group differences in the distribution of disease, health outcomes, or access to health care [1]. In order to eliminate health disparities, more efforts are needed to address social issues directly contributing to the healthy inequities observed across racial and ethnic groups. With broad support from many federal agencies, alleviating health disparities in the United States remains a goal of Healthy People 2010 [2]. However, genetic research also has a significant role to play in alleviating and understanding disparities. With tremendous advances in technology and increased investigation into human genetic variations, genomics is poised to play a valuable role in bolstering efforts to find new treatments and preventions for chronic conditions that disparately affect certain ethnic groups. The recent statement regarding the future of genomics from the National Human Genome Research Institute (NHGRI) [3] indicated that the need to develop genome-based tools to address health disparities remains a “grand challenge”. The statement acknowledges that social and economic factors contribute significantly to disparities but nevertheless assert the need for extensive research to better understand the contribution of genetics.