UAB study reveals alarming trend in cardiovascular health for foreign-born Asian Americans

UAB researchers conducted a nationwide population-level study to assess the cardiovascular health in Asian American adults. Results revealed that cardiovascular health declined in foreign-born Asian Americans by 28 percent from 2011-2020.

Stream cardiovascular health for foreign born Asian AmericansNaman Shetty, M.D., and Pankaj Arora, M.D., from the UAB Cardiovascular Institute. Researchers at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine have published a study in the American Journal of Preventive Cardiology that reveals an alarming cardiovascular health trend in foreign-born Asian Americans — a startling 28 percent decline in CVH from 2011-2020. The findings also revealed a worsening of factors influencing CVH the longer they lived in the United States, likely due to developing poor health behaviors and dietary habits, according to the researchers.

Asian Americans are the fastest-growing demographic group in the United States and are projected to account for 10 percent of the U.S. population by 2060, according to Pew Research Center. CVH in Asian Americans may be influenced by factors such as their place of birth and their duration of residence in the United States.  

“Since cardiovascular disease is the leading cause of death in Asian Americans, characterizing CVH and identifying factors that influence CVH in Asian Americans may promote targeted preventive health measures to reduce the burden of CVD,” said Naman S. Shetty, M.D., a research fellow in the Division of Cardiovascular Disease and the first author of the study.

Shetty and his team used the National Health and Nutrition Examination Survey database to analyze Asian Americans from 2011-2020 and generate nationwide population-level estimates of the CVH of approximately 8.9 million adults. The research team used Life’s Essential 8 score to quantify the CVH in this study. The LE8 score is a new metric introduced by the American Heart Association that improves the accuracy of measuring CVH.

They found that the CVH in Asian Americans declined across the decade-long study period. The team found this decline in CVH was driven by foreign-born Asian Americans, while the CVH in U.S.-born Asian Americans did not change from 2011-2020. These notable differences in the trends of CVH were attributed to social determinants of health, such as access to health care, language barriers and cultural beliefs.

The team also found that the odds of ideal CVH decreased in foreign-born Asian Americans with increasing duration of stay in the United States. The deterioration in CVH may be due to acculturation, explained Pankaj Arora, M.D., the senior author of the manuscript and an associate professor in the Division of Cardiovascular Disease and cardiologist at the UAB Cardiovascular Institute

“Acculturation is the phenomenon wherein immigrants adopt the cultural practices of the new country,” Arora said. “Initially, when Asian Americans arrive in the U.S., they tend to be healthier than the U.S. population. However, the longer they live in the U.S., the more likely they are to develop poor health behaviors and dietary habits. Over time, Asian immigrants adopt the Western dietary pattern with increased consumption of red meat, sugar-sweetened beverages and processed foods. Reassuringly, the levels of physical activity improved with increasing duration of the stay in the U.S.”

This study draws attention to the need to formulate preventive strategies to improve CVH in Asian Americans.  

“In an era of precision medicine, individualization of diagnostic thresholds and treatment strategies are a must,” Arora said. “The thresholds for the general population may not be effective in identifying high-risk individuals in Asian Americans. Recognition of lower body mass index cut-offs for obesity in Asian Americans is a step in the right direction.”  

Arora suggests that a similar approach should be utilized to define specific thresholds for each component of CVH in Asian Americans. To achieve this goal, Arora says, there is a need for greater representation of Asian Americans in research studies. Studies conducted in the Asian American population may help understand how the development of CV disease differs in Asian Americans and develop specific treatment strategies.