For decades, researchers have wondered why Latinos have significantly lower cardiovascular disease rates than non-Hispanic white people. Latinos tend to have less access to health care and can face socioeconomic challenges. In addition, the group has higher rates for diabetes, uncontrolled hypertension, and other related conditions. Why do Latinos face less risk for cardiovascular disease?
New evidence suggests that they don’t. In the article titled “Revisiting the Latino Epidemiological Paradox: An analysis of data from the All of Us Research Program,” and published on May 3 in the Journal of General Internal Medicine, researchers at the University of Miami Miller School of Medicine have shown that the Latino epidemiological paradox may not exist at all.
‘Nobody Has Been Able to Explain It’
“This paradox has been around for many years, but nobody has ever been able to explain it,” said Olveen Carrasquillo, M.D., M.P.H., professor of medicine and public health sciences, chief of the Division of General Internal Medicine, and senior author on the study. “We have this incredible new database with the All of Us Research Program, and we wanted to prove, once and for all, that the paradox exists. But the evidence showed the opposite.”
Part of the National Institutes of Health’s Precision Medicine Initiative, All of Us is gathering genetic and other data from more than a million Americans to better understand the traits that can cause disease. The University of Miami is a proud partner in the All of Us Research Program and leads the SouthEast Enrollment Center (SEEC).
Analyzing the Data
The national program has currently enrolled around 350,000 people, creating tremendous opportunity for the Miller School team to investigate population health in numerous groups, in this case Latinos.
The study, also highlighted by the NIH, examined data from more than 200,000 participants and found that 6.1% of Latinas had developed heart disease – lower than Black women (7.7%) but higher than non-Hispanic white women (3.9%). Among men, Latinos were at 9.2%, compared to Black men at 8.1% and non-Hispanic white men at 7.6%.
Faced with these findings, the group circled back and looked at the data sources most often cited as evidence for the paradox. Much of the supportive data came from mortality files and self-reported health surveys, both of which have limitations.
While the study examined data from the largest research cohort of Latinos in the U.S. (more than 40,000 enrolled), the authors caution that it is just an early step toward fully understanding these issues.
“We can’t say this is definitive at this point,” said Dr. Carrasquillo. “While this is the largest cohort of Latinos ever studied, we still need more research. I think this really calls into question whether the paradox exists or not, but it's not the final word.”
Culturally Sensitive Clinical Care
On a clinical level, Dr. Carrasquillo notes that treatments need to be developed based on a group’s cultural norms. For example, encouraging a patient to change their approach to diet and exercise may only work if family is also included in these discussions.
“We really need to think about how we tailor our treatments for the Latino population,” he said. “We also need to increase access to health care. Even with Obamacare, Latinos are much more likely to be uninsured. We must find ways to expand health coverage. This clearer picture of cardiovascular disease is just one example of why this is so important.”
The research was conducted with Miller School co-authors including Raul Montanez-Valverde, M.D.; Jacob McCauley, Ph.D.; Rosario Isasi, J.D., M.P.H.; Stephan Zuchner M.D., Ph.D., principal investigator for the All of Us SEEC; and on behalf of the SEEC investigators and the All of Us Research Program Demonstration Projects Subcommittee.
For more information on the All of Us Research program, visit here.