Ileana L. Piña, MD, MPH, on Special Considerations to Make When Assessing for CVD Risk Among Your Patients Who Are Hispanic
In this video, Ileana Piña, MD, MPH, provides insight into the factors you should consider when assessing for cardiovascular disease (CVD) risk among patients who are Hispanic. It is a topic she will be presenting about during the ASPC 2020 Virtual Summit on CVD Prevention.
Hispanic Community Health Study / Study of Latinos. National Heart, Lung, and Blood Institute (NHLBI). Accessed July 20, 2020. https://sites.cscc.unc.edu/hchs/
Ileana L. Piña, MD, MPH, is a professor of medicine at Wayne State University in Detroit, Michigan, and a heart failure transplant cardiologist.
Ileana Piña: My name is Ileana Piña, I’m a professor of medicine at Wayne State University. I'm a heart failure transplant cardiologist, and I have been very much in the thick of diversity— particularly in clinical trials—because we do take care of a diverse population both racially and ethnically diverse. At the ASPC meeting, I will be talking specifically about risk factors for cardiovascular diseases in Hispanics.
Hispanics are the largest growing minority in the United States, and after the 2020 Census, we are going to know better. The Hispanic population is clustered in areas, for example, Southern California, Texas with the Mexican border, Arizona also close to the Mexican border, but there are populations in the Bronx, where I was for 8 years; Chicago; and of course, South Florida. And just to say “Hispanic” isn't enough because Hispanic is comprised of Central American, all of Latin America, South America, and in the islands in the Caribbean, plus Spain. That’s all Hispanic. Where the patients come from varies significantly in their genetics, in the migration patterns in their own countries that may have affected risk factor burden, the acculturation once they’re in the [United States], and so there’s a lot to be considered. And we could talk about hypertension. And, for example, the incidence of hypertension is not the same in the Latin American countries as it may be, say, in Puerto Rico or the Dominican Republic, and we have a large contingency of Hispanics from Puerto Rico and from the Dominican Republic in certain geographic areas. And so to put the risk factors into that context, we really need to understand the pattern of the genetics of this population.
So in the talk, I give a lot of data from the CDC as to where the migration of the population has been moving. Certain states in the Middle Atlantic—for example, in the North Carolina, South Carolina area—there’s been an influx of Hispanics. They are primarily of Mexican background, and again Mexican background may mean more diabetes, obesity. And to really look at this, the NIH 7 or 8 years ago commissioned an epidemiologic study—I call it the Framingham of Hispanics—and it’s called Studies on Latinos or, shortened, SOL, which in Spanish stands for “sun.” And there is a wonderful website that you can get a lot of the literature that’s already been published. And there have been papers, for example, about hypertension, about heart failure, and which populations are the ones that are more likely to have these comorbidities. Hypertension, for example, in the Bronx and in that New York area, the Puerto Ricans have a very high incidence of hypertension, the Dominicans as well. Diabetes, again, very, very common in the Mexican Americans, particularly in the women, which is very interesting.
And then, of course, obesity and its relationship again to the genetics, and the culture, and the type of food, and the activity. And one of the things that SOL has done is in these multiple sub-studies, which have included 1 physical exam close to the beginning of enrollment and then another physical exam not too long ago to look at activity levels. And now we know how sedentary or how active the individuals in the cohort are, according to their background, their cultural background. So this is going to continue, and we’re going to be seeing how does disease progress in this population. And when they were enrolled, yeah, they have some comorbidities, but they were basically younger. And that’s one of the issues with the Hispanic population in the United States: They are younger than, for example, the African American population. Not all of them are reaching Medicare, but some of them are now reaching the Medicare age, and I think we’re going to start to see event rates change as patients get older, depending upon the risk factors.
So I hope I you can tune in and watch. But you can go on to the website of SOL. It is totally free, and all the papers that you would need to look at these patients so that you can translate this into your own clinic, particularly if you really service this population. Thank you for listening.