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. 1999 May;89(5):723–730. doi: 10.2105/ajph.89.5.723

Cardiovascular risk factors in Mexican American adults: a transcultural analysis of NHANES III, 1988-1994.

J Sundquist 1, M A Winkleby 1
PMCID: PMC1508740  PMID: 10224985

Abstract

OBJECTIVES: This study examined the extent to which cardiovascular disease risk factors differ among subgroups of Mexican Americans living in the United States. METHODS: Using data from a national sample (1988-1994) of 1387 Mexican American women and 1404 Mexican American men, aged 25 to 64 years, we examined an estimate of coronary heart disease mortality risk and 5 primary cardiovascular disease risk factors: systolic blood pressure, body mass index, cigarette smoking, non-high-density lipoprotein cholesterol, and type 2 diabetes mellitus. Differences in risk were evaluated by country of birth and primary language spoken. RESULTS: Estimated 10-year coronary heart disease mortality risk per 1000 persons, adjusted for age and education, was highest for US-born Spanish-speaking men and women (27.5 and 11.4, respectively), intermediate for US-born English-speaking men and women (22.5 and 7.0), and lowest for Mexican-born men and women (20.0 and 6.6). A similar pattern of higher risk among US-born Spanish-speaking men and women was demonstrated for each of the 5 cardiovascular disease risk factors. CONCLUSIONS: These findings illustrate the heterogeneity of the Mexican American population and identify a new group at substantial risk for cardiovascular disease and in need of effective heart disease prevention programs.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson N. B. Behavioral and sociocultural perspectives on ethnicity and health: introduction to the special issue. Health Psychol. 1995 Dec;14(7):589–591. [PubMed] [Google Scholar]
  2. Angell M. Privilege and health--what is the connection? N Engl J Med. 1993 Jul 8;329(2):126–127. doi: 10.1056/NEJM199307083290210. [DOI] [PubMed] [Google Scholar]
  3. Björntorp P. Metabolic implications of body fat distribution. Diabetes Care. 1991 Dec;14(12):1132–1143. doi: 10.2337/diacare.14.12.1132. [DOI] [PubMed] [Google Scholar]
  4. Boyko E. J., Keane E. M., Marshall J. A., Hamman R. F. Higher insulin and C-peptide concentrations in Hispanic population at high risk for NIDDM. San Luis Valley Diabetes Study. Diabetes. 1991 Apr;40(4):509–515. doi: 10.2337/diab.40.4.509. [DOI] [PubMed] [Google Scholar]
  5. Cowie C. C., Harris M. I., Silverman R. E., Johnson E. W., Rust K. F. Effect of multiple risk factors on differences between blacks and whites in the prevalence of non-insulin-dependent diabetes mellitus in the United States. Am J Epidemiol. 1993 Apr 1;137(7):719–732. doi: 10.1093/oxfordjournals.aje.a116732. [DOI] [PubMed] [Google Scholar]
  6. Crespo C. J., Loria C. M., Burt V. L. Hypertension and other cardiovascular disease risk factors among Mexican Americans, Cuban Americans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey. Public Health Rep. 1996;111 (Suppl 2):7–10. [PMC free article] [PubMed] [Google Scholar]
  7. Cummings S. R., Richard R. J. Optimum cutoff points for biochemical validation of smoking status. Am J Public Health. 1988 May;78(5):574–575. doi: 10.2105/ajph.78.5.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Franco L. J., Stern M. P., Rosenthal M., Haffner S. M., Hazuda H. P., Comeaux P. J. Prevalence, detection, and control of hypertension in a biethnic community. The San Antonio Heart Study. Am J Epidemiol. 1985 May;121(5):684–696. doi: 10.1093/aje/121.5.684. [DOI] [PubMed] [Google Scholar]
  9. Gillam S. Ethnicity and the use of health services. Postgrad Med J. 1990 Dec;66(782):989–993. doi: 10.1136/pgmj.66.782.989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Goff D. C., Nichaman M. Z., Chan W., Ramsey D. J., Labarthe D. R., Ortiz C. Greater incidence of hospitalized myocardial infarction among Mexican Americans than non-Hispanic whites. The Corpus Christi Heart Project, 1988-1992. Circulation. 1997 Mar 18;95(6):1433–1440. doi: 10.1161/01.cir.95.6.1433. [DOI] [PubMed] [Google Scholar]
  11. Gonzélez C., Stern M. P., Mitchell B. D., Valdez R. A., Haffner S. M., Pérez B. A. Clinical characteristics of type II diabetic subjects consuming high versus low carbohydrate diets in Mexico City and San Antonio, Texas. Diabetes Care. 1994 May;17(5):397–404. doi: 10.2337/diacare.17.5.397. [DOI] [PubMed] [Google Scholar]
  12. Guerrero-Romero F., Rodríguez-Moran M., Sandoval-Herrera F. Prevalence of NIDDM in indigenous communities of Durango, Mexico. Diabetes Care. 1996 May;19(5):547–548. doi: 10.2337/diacare.19.5.547b. [DOI] [PubMed] [Google Scholar]
  13. Haffner S. M., Miettinen H., Stern M. P. Nondiabetic Mexican-Americans do not have reduced insulin responses relative to nondiabetic non-Hispanic whites. Diabetes Care. 1996 Jan;19(1):67–69. doi: 10.2337/diacare.19.1.67. [DOI] [PubMed] [Google Scholar]
  14. Haffner S. M., Mitchell B. D., Valdez R. A., Hazuda H. P., Morales P. A., Stern M. P. Eight-year incidence of hypertension in Mexican-Americans and non-Hispanic whites. The San Antonio Heart Study. Am J Hypertens. 1992 Mar;5(3):147–153. doi: 10.1093/ajh/5.3.147. [DOI] [PubMed] [Google Scholar]
  15. Haffner S. M., Morales P. A., Hazuda H. P., Stern M. P. Level of control of hypertension in Mexican Americans and non-Hispanic whites. Hypertension. 1993 Jan;21(1):83–88. doi: 10.1161/01.hyp.21.1.83. [DOI] [PubMed] [Google Scholar]
  16. Haffner S. M., Stern M. P., Hazuda H. P., Pugh J. A., Patterson J. K. Hyperinsulinemia in a population at high risk for non-insulin-dependent diabetes mellitus. N Engl J Med. 1986 Jul 24;315(4):220–224. doi: 10.1056/NEJM198607243150403. [DOI] [PubMed] [Google Scholar]
  17. Haffner S. M., Stern M. P., Hazuda H. P., Pugh J., Patterson J. K., Malina R. Upper body and centralized adiposity in Mexican Americans and non-Hispanic whites: relationship to body mass index and other behavioral and demographic variables. Int J Obes. 1986;10(6):493–502. [PubMed] [Google Scholar]
  18. Haffner S. M., Stern M. P., Hazuda H. P., Rosenthal M., Knapp J. A. The role of behavioral variables and fat patterning in explaining ethnic differences in serum lipids and lipoproteins. Am J Epidemiol. 1986 May;123(5):830–839. doi: 10.1093/oxfordjournals.aje.a114312. [DOI] [PubMed] [Google Scholar]
  19. Haffner S., González Villalpando C., Hazuda H. P., Valdez R., Mykkänen L., Stern M. Prevalence of hypertension in Mexico City and San Antonio, Texas. Circulation. 1994 Sep;90(3):1542–1549. doi: 10.1161/01.cir.90.3.1542. [DOI] [PubMed] [Google Scholar]
  20. Hamman R. F., Marshall J. A., Baxter J., Kahn L. B., Mayer E. J., Orleans M., Murphy J. R., Lezotte D. C. Methods and prevalence of non-insulin-dependent diabetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study. Am J Epidemiol. 1989 Feb;129(2):295–311. doi: 10.1093/oxfordjournals.aje.a115134. [DOI] [PubMed] [Google Scholar]
  21. Hanis C. L. Hypertension among Mexican Americans in Starr County, Texas. Public Health Rep. 1996;111 (Suppl 2):15–17. [PMC free article] [PubMed] [Google Scholar]
  22. Harris M. I. Epidemiological correlates of NIDDM in Hispanics, whites, and blacks in the U.S. population. Diabetes Care. 1991 Jul;14(7):639–648. doi: 10.2337/diacare.14.7.639. [DOI] [PubMed] [Google Scholar]
  23. Havel R. J., Rapaport E. Management of primary hyperlipidemia. N Engl J Med. 1995 Jun 1;332(22):1491–1498. doi: 10.1056/NEJM199506013322207. [DOI] [PubMed] [Google Scholar]
  24. House J. S., Kessler R. C., Herzog A. R. Age, socioeconomic status, and health. Milbank Q. 1990;68(3):383–411. [PubMed] [Google Scholar]
  25. Kamboh M. I., Rewers M., Aston C. E., Hamman R. F. Plasma apolipoprotein A-I, apolipoprotein B, and lipoprotein(a) concentrations in normoglycemic Hispanics and non-Hispanic whites from the San Luis Valley, Colorado. Am J Epidemiol. 1997 Dec 15;146(12):1011–1018. doi: 10.1093/oxfordjournals.aje.a009229. [DOI] [PubMed] [Google Scholar]
  26. Kaplan G. A., Keil J. E. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993 Oct;88(4 Pt 1):1973–1998. doi: 10.1161/01.cir.88.4.1973. [DOI] [PubMed] [Google Scholar]
  27. Karter A. J., Mayer-Davis E. J., Selby J. V., D'Agostino R. B., Jr, Haffner S. M., Sholinsky P., Bergman R., Saad M. F., Hamman R. F. Insulin sensitivity and abdominal obesity in African-American, Hispanic, and non-Hispanic white men and women. The Insulin Resistance and Atherosclerosis Study. Diabetes. 1996 Nov;45(11):1547–1555. doi: 10.2337/diab.45.11.1547. [DOI] [PubMed] [Google Scholar]
  28. Khan L. K., Sobal J., Martorell R. Acculturation, socioeconomic status, and obesity in Mexican Americans, Cuban Americans, and Puerto Ricans. Int J Obes Relat Metab Disord. 1997 Feb;21(2):91–96. doi: 10.1038/sj.ijo.0800367. [DOI] [PubMed] [Google Scholar]
  29. Leaverton P. E., Sorlie P. D., Kleinman J. C., Dannenberg A. L., Ingster-Moore L., Kannel W. B., Cornoni-Huntley J. C. Representativeness of the Framingham risk model for coronary heart disease mortality: a comparison with a national cohort study. J Chronic Dis. 1987;40(8):775–784. doi: 10.1016/0021-9681(87)90129-9. [DOI] [PubMed] [Google Scholar]
  30. Luepker R. V., Rosamond W. D., Murphy R., Sprafka J. M., Folsom A. R., McGovern P. G., Blackburn H. Socioeconomic status and coronary heart disease risk factor trends. The Minnesota Heart Survey. Circulation. 1993 Nov;88(5 Pt 1):2172–2179. doi: 10.1161/01.cir.88.5.2172. [DOI] [PubMed] [Google Scholar]
  31. Marmot M. G., Syme S. L., Kagan A., Kato H., Cohen J. B., Belsky J. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of coronary and hypertensive heart disease and associated risk factors. Am J Epidemiol. 1975 Dec;102(6):514–525. doi: 10.1093/oxfordjournals.aje.a112189. [DOI] [PubMed] [Google Scholar]
  32. McDowell A., Engel A., Massey J. T., Maurer K. Plan and operation of the Second National Health and Nutrition Examination Survey, 1976-1980. Vital Health Stat 1. 1981;(15):1–144. [PubMed] [Google Scholar]
  33. Mitchell B. D., Kammerer C. M., Blangero J., Mahaney M. C., Rainwater D. L., Dyke B., Hixson J. E., Henkel R. D., Sharp R. M., Comuzzie A. G. Genetic and environmental contributions to cardiovascular risk factors in Mexican Americans. The San Antonio Family Heart Study. Circulation. 1996 Nov 1;94(9):2159–2170. doi: 10.1161/01.cir.94.9.2159. [DOI] [PubMed] [Google Scholar]
  34. Pugh J. A., Stern M. P., Haffner S. M., Hazuda H. P., Patterson J. Detection and treatment of hypercholesterolemia in a biethnic community, 1979-1985. J Gen Intern Med. 1988 Jul-Aug;3(4):331–336. doi: 10.1007/BF02595790. [DOI] [PubMed] [Google Scholar]
  35. Ramirez A. G. Hypertension in Hispanic Americans: overview of the population. Public Health Rep. 1996;111 (Suppl 2):25–26. [PMC free article] [PubMed] [Google Scholar]
  36. Reed D., McGee D., Cohen J., Yano K., Syme S. L., Feinleib M. Acculturation and coronary heart disease among Japanese men in Hawaii. Am J Epidemiol. 1982 Jun;115(6):894–905. doi: 10.1093/oxfordjournals.aje.a113377. [DOI] [PubMed] [Google Scholar]
  37. Rosenwaike I. Mortality differentials among persons born in Cuba, Mexico, and Puerto Rico residing in the United States, 1979-81. Am J Public Health. 1987 May;77(5):603–606. doi: 10.2105/ajph.77.5.603. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Salmond C. E., Prior I. A., Wessen A. F. Blood pressure patterns and migration: a 14-year cohort study of adult Tokelauans. Am J Epidemiol. 1989 Jul;130(1):37–52. doi: 10.1093/oxfordjournals.aje.a115321. [DOI] [PubMed] [Google Scholar]
  39. Shaukat N., de Bono D. P., Cruickshank J. K. Clinical features, risk factors, and referral delay in British patients of Indian and European origin with angina matched for age and extent of coronary atheroma. BMJ. 1993 Sep 18;307(6906):717–718. doi: 10.1136/bmj.307.6906.717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Sorel J. E., Ragland D. R., Syme S. L. Blood pressure in Mexican Americans, whites, and blacks. The Second National Health and Nutrition Examination Survey and the Hispanic Health and Nutrition Examination Survey. Am J Epidemiol. 1991 Aug 15;134(4):370–378. doi: 10.1093/oxfordjournals.aje.a116099. [DOI] [PubMed] [Google Scholar]
  41. Sorlie P. D., Backlund E., Johnson N. J., Rogot E. Mortality by Hispanic status in the United States. JAMA. 1993 Nov 24;270(20):2464–2468. [PubMed] [Google Scholar]
  42. Stern M. P., Gonzalez C., Mitchell B. D., Villalpando E., Haffner S. M., Hazuda H. P. Genetic and environmental determinants of type II diabetes in Mexico City and San Antonio. Diabetes. 1992 Apr;41(4):484–492. doi: 10.2337/diab.41.4.484. [DOI] [PubMed] [Google Scholar]
  43. Stern M. P., Rosenthal M., Haffner S. M., Hazuda H. P., Franco L. J. Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans. The San Antonio Heart Study. Am J Epidemiol. 1984 Dec;120(6):834–851. doi: 10.1093/oxfordjournals.aje.a113956. [DOI] [PubMed] [Google Scholar]
  44. Sundquist J., Johansson S. E. Long-term illness among indigenous and foreign-born people in Sweden. Soc Sci Med. 1997 Jan;44(2):189–198. doi: 10.1016/s0277-9536(96)00145-1. [DOI] [PubMed] [Google Scholar]
  45. Sundquist J., Johansson S. E. The influence of country of birth on mortality from all causes and cardiovascular disease in Sweden 1979-1993. Int J Epidemiol. 1997 Apr;26(2):279–287. doi: 10.1093/ije/26.2.279. [DOI] [PubMed] [Google Scholar]
  46. Sundquist J. Living conditions and health. A population-based study of labour migrants and Latin American refugees in Sweden and those who were repatriated. Scand J Prim Health Care. 1995 Jun;13(2):128–134. doi: 10.3109/02813439508996749. [DOI] [PubMed] [Google Scholar]
  47. Treviño F. M., Moyer M. E., Valdez R. B., Stroup-Benham C. A. Health insurance coverage and utilization of health services by Mexican Americans, mainland Puerto Ricans, and Cuban Americans. JAMA. 1991 Jan 9;265(2):233–237. doi: 10.1001/jama.1991.03460020087034. [DOI] [PubMed] [Google Scholar]
  48. Vega W. A., Amaro H. Latino outlook: good health, uncertain prognosis. Annu Rev Public Health. 1994;15:39–67. doi: 10.1146/annurev.pu.15.050194.000351. [DOI] [PubMed] [Google Scholar]
  49. Wei M., Valdez R. A., Mitchell B. D., Haffner S. M., Stern M. P., Hazuda H. P. Migration status, socioeconomic status, and mortality rates in Mexican Americans and non-Hispanic whites: the San Antonio Heart Study. Ann Epidemiol. 1996 Jul;6(4):307–313. doi: 10.1016/s1047-2797(96)00026-9. [DOI] [PubMed] [Google Scholar]
  50. Williams R., Bhopal R., Hunt K. Coronary risk in a British Punjabi population: comparative profile of non-biochemical factors. Int J Epidemiol. 1994 Feb;23(1):28–37. doi: 10.1093/ije/23.1.28. [DOI] [PubMed] [Google Scholar]
  51. Williams R. Health and length of residence among south Asians in Glasgow: a study controlling for age. J Public Health Med. 1993 Mar;15(1):52–60. doi: 10.1093/oxfordjournals.pubmed.a042820. [DOI] [PubMed] [Google Scholar]
  52. Winkleby M. A., Fortmann S. P., Barrett D. C. Social class disparities in risk factors for disease: eight-year prevalence patterns by level of education. Prev Med. 1990 Jan;19(1):1–12. doi: 10.1016/0091-7435(90)90001-z. [DOI] [PubMed] [Google Scholar]
  53. Winkleby M. A., Fortmann S. P., Rockhill B. Health-related risk factors in a sample of Hispanics and whites matched on sociodemographic characteristics. The Stanford Five-City Project. Am J Epidemiol. 1993 Jun 15;137(12):1365–1375. doi: 10.1093/oxfordjournals.aje.a116646. [DOI] [PubMed] [Google Scholar]
  54. Winkleby M. A., Gardner C. D., Taylor C. B. The influence of gender and socioeconomic factors on Hispanic/white differences in body mass index. Prev Med. 1996 Mar-Apr;25(2):203–211. doi: 10.1006/pmed.1996.0047. [DOI] [PubMed] [Google Scholar]
  55. Winkleby M. A., Kraemer H. C., Ahn D. K., Varady A. N. Ethnic and socioeconomic differences in cardiovascular disease risk factors: findings for women from the Third National Health and Nutrition Examination Survey, 1988-1994. JAMA. 1998 Jul 22;280(4):356–362. doi: 10.1001/jama.280.4.356. [DOI] [PubMed] [Google Scholar]
  56. Winkleby M. A., Schooler C., Kraemer H. C., Lin J., Fortmann S. P. Hispanic versus white smoking patterns by sex and level of education. Am J Epidemiol. 1995 Aug 15;142(4):410–418. doi: 10.1093/oxfordjournals.aje.a117649. [DOI] [PubMed] [Google Scholar]
  57. Yamamoto-Kimura L., Zamora-González J., Huerta-Alvarado S., Fajardo-Gutiérrez A., Cardoso-Saldaña G., Posadas-Romero C. High blood pressure and cardiovascular risk factors in an adult population of Mexico City. Characteristics of the studied population. Arch Med Res. 1996 Summer;27(2):213–222. [PubMed] [Google Scholar]

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