CHICAGO — Despite the underrepresentation of Hispanics in heart failure trials, evidence has emerged suggesting that they have unique risk factors and outcomes that must be taken into clinical consideration.
The evidence also underscores the need to recognize the vast heterogeneity of Hispanics, Dr. Ileana Piña said at a meeting sponsored by the International Society on Hypertension in Blacks.
“Hispanics represent a cultural group, not a racially identifiable group,” said the Cuban-born cardiologist. “You can't lump them all together.”
But that's exactly what has happened. It wasn't until the 2000 U.S. census that the term “Hispanic” was changed to “Spanish, Hispanic, or Latino” to describe persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Several studies have made the observation—coined the “Hispanic paradox”—that Hispanics have lower all-cause and cardiovascular mortality, despite increased obesity and diabetes, and lower socioeconomic status, said Dr. Piña, professor of medicine at Case Western Reserve University, Cleveland.
A study of Medicare enrollees found that Hispanics were 1.2 times more likely to be hospitalized for heart failure than were whites, while blacks were 1.5 times more likely. But after adjustment for sex and age, in-hospital mortality was significantly lower in Hispanics and blacks than in whites. A California study also showed that blacks and “Latinos” initially hospitalized with heart failure in 1991 or 1992 were more likely to be rehospitalized than were Asians and whites, but were less likely to die during the following year.
Sociocultural factors are often used to explain the Hispanic paradox, but more recent data are causing some to rethink the paradox or at least to differentiate Hispanics by birthplace. Among diabetics in the San Antonio Heart Study, age- and sex-adjusted hazard ratios indicated that U.S.-born Mexican-Americans have a 66% greater risk of all-cause and CV mortality, compared with non-Hispanic whites, while Mexico-born Mexican-Americans appeared to be at similar risk.
Greater representation in patient registries, research studies, and clinical trials is needed Dr. Piña said. Only one major heart failure trial, HF-ACTION, has specifically differentiated Hispanics, and those patients made up just 3%.
Greater elucidation of heart failure risk factors and outcomes in Hispanic populations could lead to more targeted therapies and risk modification. With one in three U.S. residents expected to be Hispanic by 2050, there is great urgency to act, said Dr. Piña, who disclosed serving as a speaker for AstraZeneca, Novartis, and Merck.