Mega Doctor News
By American Heart Association
Cardiovascular disease is the leading cause of death for Hispanic and Latino people in the United States. But the challenges they face are hardly the whole story, say experts who helped write a new report on the heart health of these communities.
Yes, Hispanic people face many risk factors, said Dr. Yamnia I. Cortés, an associate professor at the University of Iowa College of Nursing in Iowa City. “But then there are real strengths.”
Cortés was a co-author of the report, an American Heart Association scientific statement on the state of heart disease and stroke health in these communities. It was published in September in the journal Circulation.
Here’s a look at some of the biggest heart health issues facing Hispanic people in the U.S. – and how cultural traditions might help them stay healthy.
How do heart disease and stroke risks vary among Hispanic communities?
The statement acknowledges that while the number of Hispanic people in the U.S. is vast – about a fifth of the population – the label “Hispanic” embraces many cultures.
“We are not monolithic,” said Dr. Johanna Contreras, the statement’s lead author. She is an associate professor at the Icahn School of Medicine at Mount Sinai in New York and medical director of the hospital’s Hispanic Heart Center.
Among the differences:
- Type 2 diabetes is most prevalent among Mexican and Puerto Rican adults.
- High blood pressure, or hypertension, is most common among those of Puerto Rican, Cuban and Dominican heritage.
- While cholesterol issues affect about a third of Hispanic adults, high levels of “bad” cholesterol are more common in Cuban people, while high levels of triglycerides, a type of fat in the blood, are more common among Dominican people.
Diversity among Hispanic people goes beyond geography, Contreras said. People have different incomes, language abilities and access to healthcare. The experiences of someone who moved to the United States as a young, bilingual person differ from those of someone older and less likely to accommodate to the new environment.
Studies have suggested that as a whole, Hispanic people in the U.S. tended to have lower risk of dying from heart disease than non-Hispanic white people despite having higher risk factors. But as more detailed research has been done, this “Hispanic paradox” is looking more like “an oversimplification,” Contreras said.
What heart disease risk factors affect Hispanic adults most?
High blood pressure and diabetes are top concerns, Contreras said.
- High blood pressure rates for Hispanic people overall are similar to rates of non-Hispanic white people, the statement says, but awareness, treatment and control rates are lower.
- Type 2 diabetes is nearly twice as prevalent among Hispanic adults as compared with non-Hispanic white adults, the statement says.
Both Contreras and Cortés said awareness is an issue among the people they work with. “People do not know they have diabetes,” Cortés said, and they don’t understand its consequences.
Diabetes, which causes blood sugar levels to be too high, can damage the eyes, kidneys, nerves and heart. It can lead to complications such as peripheral artery disease, in which narrowed arteries reduce blood flow to the arms and legs, and amputations.
Contreras has treated patients who told her, “‘My mom had a leg amputated.’ I said, ‘Oh, yeah, probably because of diabetes.’ And the person said, ‘No, no, she just had some problem with her blood vessels.’”
Obesity is linked to both diabetes and high blood pressure. Almost half of Hispanic adults have obesity. It’s more common among those born in the U.S., and rates are highest in people of Puerto Rican and Dominican heritage.
How can Hispanic cultural strengths support heart health?
Contreras and Cortés said that many aspects of traditional culture in Hispanic communities can be great for heart health.
Traditional foods can be healthy, Contreras said, and many people like to go to the market and get fresh fruit and fresh vegetables or grow their own. Fruits and vegetables are a key part of heart-healthy eating.
A lot of the celebrations in Hispanic heritage groups center around eating, Contreras said. And traditionally, Hispanic households “love to cook, and they cook well.” Avoiding highly processed foods is also part of healthy eating.
An emphasis on family and community also helps, Cortés said, describing that “sense of being surrounded by people who are there to support you. It’s not necessarily even like immediate family – it’s extended family, too.”
The statement says the idea of familismo, a strong sense of family loyalty and obligation, has been linked to lower youth depression and stronger feelings of social support. Social network and connections are a key to heart health.
Hispanic adults are less likely than other racial and ethnic groups in the U.S. to meet recommended physical activity levels, but Contreras has used the love of socializing to encourage it. When she’s had patients who were reluctant to exercise in a gym, for example, she’s told them, “‘OK, let’s join a soccer team.’ They like to be with people, which is important.”
Contreras uses family as a way to encourage people to get physical activity, reminding adults, “your kids are seeing what you do.”
She asks them to use their family time as a way to talk about family health history, which can be a problem for Hispanic and non-Hispanic cultures alike, she said.
“Nobody likes to talk about diseases or the risk factors,” she said, recalling a patient who reported no family history of high blood pressure or diabetes. But when Contreras met the patient’s mother, she said, “Oh, yeah, I’ve had diabetes for 20 years.”
The statement also discusses personalismo, an emphasis on trusted relationships, as an opportunity for healthcare professionals to make connections.
Contreras works with community organizations, churches and Spanish-language media, because she knows that when people in the community see a familiar face, “they’re more likely to listen, and they’re more likely to understand.”
What Hispanic cultural factors can create health challenges?
Hispanic cultural traditions can also have a less-healthy side.
Some popular foods – plantains, or empanadas – are usually fried, and a lot of recipes call for lard, Cortés said.
Small adjustments can make them healthier, she said. Plantains can be baked and served with ground turkey instead of beef. Corn tortillas offer healthy whole grains and less sodium than flour.
Contreras said that people can enjoy such changes while still embracing their traditional love of good food. “I always tell them, ‘Let’s take advantage of this, and let’s do it in the healthier way. It’s going to taste exactly the same, and it’s going to make all of us healthy.’”
Gender roles can pose problems, especially for women. Marianismo, the statement says, is the idea that women embody family devotion and emotional restraint. “It’s the self-sacrifice,” Cortés said. “You put everyone above yourself.”
A mother’s dedication can be used for good, Contreras said. “The positive thing is that when you’re educating mom and get her healthy, you are also educating her family because she will be more likely to make sure her family does the same thing.”
Interestingly, the statement notes that Hispanic women report higher rates of depression and anxiety than Hispanic men, so mental health is something that is equally important as physical health.
“We have to empower women, empower their own health and talk about prevention,” Contreras said.
The emphasis on community connections can be a barrier if it keeps people from listening to their physicians. The statement says a reliance on non-medical expert sources for health information can make people more likely to encounter inaccurate health information.
Contreras values making connections, but a lack of Hispanic healthcare professionals is a barrier, the statement says. Having more Hispanic physicians is associated with improved patient trust and increased odds they will follow through with preventive care, the statement says, but fewer than 6% of cardiologists are Hispanic.
That’s part of what makes efforts to recruit and train more Hispanic healthcare professionals, through efforts such as the American Heart Association’s National Hispanic Latino Cardiovascular Collaborative program, vital, Contreras said.
Using Hispanic cultural strengths to improve heart health
The statement calls culturally tailored efforts such as using promotores de salud – community health workers – essential to care. But Contreras said there are other ways for Hispanic people to support their community’s health.
Because researchers lack data on Hispanic people, she works to recruit people to enroll in heart health studies.
And she wants people to think about everyone around them as they take steps to stay heart healthy.
“Create impact in your own community,” she tells people who want to fight heart disease, “because if it’s attacking you, it’s attacking everybody else.”
