Thread by @DrDamluji

Epidemiology of Diabetes and Atherosclerotic Cardiovascular Disease Among Asian American Adults: Implications, Management, and Future Directions: A Scientific Statement From the American Heart Association: @CircAHA

Nice statement on high risk group

Summary 👇👇👇

1/ 🌏 Asian Americans (AsA) are the fastest growing ethnic group in the US 🇺🇸. They face high risks of Type 2 diabetes (T2D) & atherosclerotic cardiovascular disease (ASCVD) - major risks.

2/ 📊 Yet, most studies lump all AsA subgroups in one category, potentially hiding disparities in T2D & ASCVD prevalence.

3/🧬 In this scientific statement, the authors aimed to summarize demographics, biological & social factors contributing to T2D & ASCVD in AsA adults. Plus, it explores culturally appropriate prevention strategies.

4/ 📈 By 2050, AsA adults are projected to be the largest immigrant group in the US, making up 36% of all immigrants.

5/ ✈️ Immigration has been influenced by policy, and AsA subgroups have unique migration histories, affecting where they reside and their health risks.

6/ 📝 It's imp to understand these differences, develop tailored strategies, and conduct future research to help reduce T2D & ASCVD in AsA adults.

7/ 💼 Socioeconomic factors like income and immigration patterns affect AsA subgroups differently, influencing T2D & ASCVD risks.

8/ 🔬 Epidemiological studies show a significant variation in T2D prevalence across AsA subgroups.

9/ 1🤰 Gestational diabetes, an important risk factor for T2D, also shows similar variations across AsA subgroups.

10/ 💉 ADA guidelines recommend T2D screening for AsA adults with BMI ≥23 kg/m2 and at least one additional risk factor. #DiabetesScreening #healthcare

11/ 🧪 Studies suggest that South Asian adults have more hepatic & intermuscular fat, leading to insulin resistance and increased susceptibility to T2D.

12/ 🚨 Wide variation in CAD risk among Asian subgroups!

**South Asian adults face the highest risk compared to East Asian adults**

💔 INTERHEART study: South Asians experience CAD at younger ages than Western Europe or East Asia counterparts. 📉

13/ 👨‍⚕️👩‍⚕️ Higher CAD prevalence in Asian Indian men, followed by Filipino men & Korean women. South Asians 4x-6x higher risk than NH White, Japanese, Filipino & Chinese adults.

⚠️ Mortality rates in certain AsA subgroups now as high as NH White adults.

14/ ❗️ASCVD risk assessment: Pooled Cohort Equations may underestimate risk in South Asian people & overestimate risk in East Asian adults.

🧠 Stroke prevalence higher in Asian populations, especially hemorrhagic stroke among Chinese, Japanese, and Filipino adults.

15/ 1🩺 Filipino adults had highest age-adjusted overall stroke prevalence rate. AsA individuals experience more severe strokes, disability, and complications.

16/ 💡Peripheral Artery Disease (PAD) in Asian adults: Limited data but prevalence remains low.

🔝🟡 Black adults have highest rates of PAD, followed by NH White adults; Hispanic American & AsA individuals have lowest rates.

17/ 📋 California outpatient healthcare database from Kaiser: PAD prevalence highest in Asian Indian adults (1.4%) & lowest in Chinese adults (0.9%).

18/🏥 National Inpatient Sample: Asian/Pacific Islander people had higher all-cause mortality, longer hospital stays, and higher inpatient costs compared to NH White adults.

(less accurate; but some data here)

19/ Obesity: BMI distribution varies across AsA subgroups. East Asian adults have lower average BMI than South & Southeast Asian adults.

20/🔍 Hypertension: Higher prevalence in Southeast Asian adults compared to other subgroups. Heterogeneity exists among pregnant AsA populations, with highest de novo hypertension rate observed among Filipino adults.

21/ 🥼 Hyperlipidemia: Significant heterogeneity exists among AsA subgroups. Higher prevalence of self-reported high cholesterol among Asian immigrants born in Southeast Asia.

22/ 🔎 Pattern of lower HDL cholesterol & higher triglycerides found in Asian Indian, Chinese, Filipino, and Korean men & women compared to NH White adults.

23/ 🚩 Lipoprotein(a) [Lp(a)] may be an important risk factor, found to be higher among South Asian adults compared to NH White adults.

#PeripheralArteryDisease #PAD

24/ 🧬 Genetics play an imp role in ASCVD risk factors among Asian Americans.

While some genetic risk factors are common across ancestries, others may be unique to specific Asian populations.

Remember: race & ethnicity are social constructs!

#CardioTwitter

25/ 🍲🥢 Acculturation & lifestyle changes are important factors affecting the risk of atherosclerosis among Asian Americans.

As individuals become more acculturated, they may adopt a Western dietary pattern while maintaining traditional eating habits = increases risk

26/ 🏃‍♀️However, acculturation may also be associated with physical activity levels among Asian Americans.

27/ 🚭 Acculturation influences smoking behavior among Asian immigrants. Interventions tailored to the specific needs of Asian Americans are necessary to address disparities in cardiovascular risk factors. #NoTobacco

28/ 🍎🥗 Clinicians should consider cultural competency when providing dietary interventions & promoting physical activity among Asian Americans.

Cessation programs for smoking should be adapted to the unique needs of this population.

29/ 💡 In conclusion, both modifiable & nonmodifiable factors contribute to the risk of atherosclerosis in Asian Americans.

***Addressing these disparities through culturally sensitive interventions can help improve cardiovascular health in this population.

30/ 🍽️ Asian diets vary across regions, but it's important to understand these differences in order to create heart-healthy dietary recommendations for Asian Americans: focus on whole grains, minimized refined carbs, and reduced red meat consumption. 🌾🥦 #Diet

@ShariqShamimMD

31/ 💪 Physical activity is imp in preventing chronic conditions like T2D and ASCVD. However, data suggests that Asian American adults are less active than other ethnic groups. Increasing awareness & promoting physical activity is key.

32/ 🚭 Tobacco use is a major modifiable risk factor for ASCVD. Although smoking cessation strategies exist, their success in Asian American populations is unclear. Culturally relevant interventions should incorporate social network & support.

33/ 😴 Sleep is vital for overall health, especially CVH.

Racial and ethnic minorities may experience more adverse sleep patterns, increasing their ASCVD risk.

Addressing acculturative stress and enhancing protective factors can improve sleep outcomes.

34/ 🌐 Community-based efforts can help educate Asian immigrants on the health risks associated with tobacco use. By considering family characteristics, social networks, and community resources, culturally relevant prevention and cessation interventions can be developed.

#epi

35/ 💊 Lifestyle interventions have proven to be effective in preventing diabetes among Asian populations. Programs like the Diabetes Prevention Program have demonstrated greater efficacy than pharmacological agents like metformin.

36/ 💊 Pharmacological management of T2D in Asian Americans is generally similar to non-Asian patients. Metformin is the first-line medication, but newer medications like sodium-glucose cotransporter-2 inhibitors & glucagon-like peptide-1 receptor antagonists may be beneficial.

37/ 🌡️ Cholesterol-lowering therapies are vital for ASCVD risk reduction in T2D. While East Asian populations might experience more adverse events from statins, South Asian adults show similar efficacy and safety as NH White adults.

38/ 🩺 Blood pressure management is imp for T2D patients. Despite racial & ethnic variations in hypertension prevalence & treatment, there's no specific recommendation on antihypertensive drugs for Asian American adults. 🌡️

39/ 🧘 Yoga, meditation, and Tai Chi are among the CAMs that have been studied for T2D management. Although some benefits have been observed, more evidence is needed to confirm their efficacy in improving glycemic control.

40/ In conclusion, understanding T2D and ASCVD risks among Asian American subgroups is important

Addressing data limitations and implementing culturally specific recommendations will improve prevention and health outcomes for #AsianAmericans!

read full statement: 👇👇

DOI:10.1161/CIR.0000000000001145