Impact of Individual and Neighborhood Factors on Cardiovascular Risk in White Hispanic and Non‐Hispanic Women and Men

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Excerpt

Cardiovascular disease (CVD) is the leading cause of mortality for adults in the United States (US) regardless of ethnicity (Heron, 2012). Yet, cardiac and non‐cardiac‐related risk factors vary by ethnicity, as do mortality rates. When compared to non‐Hispanic Whites (NHWs), Hispanics in the US have a higher prevalence of certain risk factors but have a lower overall cardiac mortality rate (Daviglus et al., 2012). The 10‐year Framingham General Cardiovascular Risk Score (FRS‐10) has long been considered a gold standard for estimating the likelihood of developing a serious cardiovascular event in the next 10 years for the general population (Barlow et al., 2012; Expert Panel, 2001). However, results may overestimate the risk of cardiac events and mortality for Hispanics when compared to their actual mortality (Cortes‐Bergoderi et al., 2013). The FRS‐10 formula does not include important CVD risk factors, such as diastolic blood pressure, low‐density lipoprotein (LDL), triglycerides, and hemoglobin Alc (HbAlc) (Cohn, unpublished data; Cortes‐Bergoderi et al., 2013; Lloyd‐Jones, 2010). The disparity between prevalence of risk factors considered in the FRS‐10 formula and actual cardiac mortality rates for Hispanics in the US suggests that other factors may contribute to or protect against cardiac mortality.
One source of CVD risk may be environmental context. Neighborhood‐level characteristics may be potential risk or protective factors. Low neighborhood socioeconomic status (NSES) has been associated with increased prevalence of CVD risks of obesity, diabetes, and smoking (Boykin et al., 2011; Salinas, Abdelbary, et al., 2012). Neighborhoods with high Hispanic concentration have also had higher prevalence of obesity (Do et al., 2007; Salinas, Rocha, Abdelbary, Gay, & Sexton, 2012). Findings are inconsistent, however. Kershaw, Osypuk, Do, Chavez, and Diez Roux (2015) studied neighborhood‐level ethnic concentration and found it was not was not associated with CVD risk among Hispanics.
The unexplained difference in estimated CVD risk versus cardiac mortality rates for Hispanics in the US impairs accurate assessment of CVD risk to plan appropriate treatment, medication, and behavioral interventions. The purpose of this study was to examine relationships among individual‐ and neighborhood‐level CVD risk factors, neighborhood‐level cardiac mortality rates, and individual‐level estimated CVD risk for White Hispanic and Non‐Hispanic White women and men in Miami‐Dade County, FL. Study aims were to: (a) identify differences in individual‐ and neighborhood‐level risk factors, cardiac mortality rates and estimated CVD risk across race/ethnicity and sex subgroups; (b) determine whether neighborhood‐level characteristics were associated with cardiac mortality rates and estimated CVD risk; and (c) determine whether selected individual‐ and neighborhood‐level characteristics predicted estimated CVD risk for White Hispanic and non‐Hispanic women and men.

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