MIAMI BEACH – Metabolic syndrome drives the cardiovascular disease risk disparity for young and middle-age Hispanics more than for other women, according to a large community-based study of 6,843 women.
Hispanic women deserve additional attention to mitigate risk factors and intervention to ultimately lessen their cardiometabolic risk, Dr. Fatima Rodriguez said.
Overall, increasing age was associated with a higher prevalence of metabolic syndrome. However, compared with white and black women, Hispanics had the highest rates across all ages in the cross-sectional study. The Hispanic women aged 30-65 years had the greatest disparity in metabolic syndrome rates, suggesting this age group is at particular risk, Dr. Rodriguez said at the annual meeting of the International Society on Hypertension in Blacks.
Dr. Fatima Rodriguez
Dr. Rodriguez and her colleagues assessed data from Sister to Sister: The Women’s Heart Health Foundation collected through free health screenings in 17 U.S. cities. In 2008 and 2009, 18,892 women were screened for obesity (using both body mass index and waist circumference), hypertension, hyperglycemia, and dyslipidemia. These women also completed cardiovascular risk questionnaires. Nearly 7,000 women had complete clinical and demographic data and were studied further.
"This was a very diverse sample," Dr. Rodriguez said. A total 42% self-identified as non-Hispanic white, 37% as black, 13% as Hispanic, and 8% as "other" race or ethnicity.
Overall prevalence of metabolic syndrome in the study was high, at 35%. In addition, "there was a disproportionate burden for Hispanic women and black women," said Dr. Rodriguez, an internal medicine resident at Brigham and Women’s Hospital in Boston. A total 40% of Hispanic women met the criteria for metabolic syndrome, as did 39% of black women, 31% of non-Hispanic white women, and 29% of women who identified as "other."
For Hispanic woman, much of the disparity is driven by abnormal lipid levels. "Many of these women have high triglyceride levels and low HDL levels ... and this disparity was most pronounced in young women," Dr. Rodriguez said. "It is a different pattern than the metabolic syndrome in black women, where it’s largely driven by waist circumference and hypertension."
In addition to assessment of race/ethnicity and age, a third objective of the study was to identify risk-adjusted predictors of metabolic syndrome. The No.1 predictor was Hispanic ethnicity (odds ratio, 1.65), followed by being black (OR, 1.39), compared with non-Hispanic whites. Smoking also was an independent predictor for the syndrome (OR, 1.30), as was increasing age (OR, 1.13).
Dr. Rodriguez and her colleagues used the National Cholesterol Education Program definition (NCEP ATP III) for metabolic syndrome. Women had to meet at least three of the following criteria: waist circumference of at least 35 inches; triglyceride level of at least 150 mg/dL; HDL cholesterol below 50 mg/dL; systolic blood pressure at least 130 mm Hg, or diastolic blood pressure at least 85mm Hg; or pharmacologic treatment for hypertension; or a fasting glucose of at least 110 mg/dL.
Use of cross-sectional data in the current study limits assessment of any causality. Other potential limitations include aggregating all Hispanic women into one group (even though there is a great deal of heterogeneity among Hispanics) and an inability to account for lifestyle or patient level factors (for example, diet or exercise).
A disparity in insurance status was another finding. "One thing that was very interesting in this study was the high rates of lack of insurance for Hispanic women. Alarmingly, almost 65% of these women were uninsured had no insurance whatsoever," Dr. Rodriguez said. "This suggests these women have little access to the health care setting and a population-based approach would be best for primary prevention."
Dr. Rodriguez said that she had no financial disclosures.