A new way of analyzing the factors that contribute to cardiovascular disease in ethnic and cultural groups provides a far more accurate picture of Hispanic health in America than previous reports and points to more effective methods for conducting research on ethnically, geographically, racially and culturally diverse populations. “Hispanic people are currently more than 16 percent of the United States population, making them the country’s largest ethnic minority group, but they are very poorly studied,” explains Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Scholar 2007-2011 Carlos Rodriguez, M.D., M. P.H.
A cardiologist and assistant professor of medicine and epidemiology at Columbia’s College of Physicians and Surgeons, Rodriguez’s research looks at Hispanics as a heterogeneous, rather than homogeneous group—an uncommon practice among researchers. As a result, his work reveals a far more complex picture of health problems as they affect people from Mexico, the Dominican Republic and other parts of the world.
Rodriguez’s study, “Left Ventricular Mass and Ventricular Remodeling Among Hispanic Subgroups Compared with Non-Hispanic Blacks and Whites,” published in the January issue of the Journal of the American College of Cardiology, was the first to compare Hispanics from varied ethnic and cultural backgrounds in a single cohort when looking at their cardiovascular risk factors. “We looked at subgroups from Cuba, Mexico, the Caribbean, Central and South America,” Rodriguez said “and found that as a group, all Hispanics had a higher prevalence of left ventricular hypertrophy [LVH or an enlarged heart] and abnormal left-ventricular remodeling, but there were significant differences in the prevalence of risk factors for LVH.
Specifically, people from the Caribbean had higher rates of hypertension compared to non-Hispanic whites. Hispanics of Mexican origin had a low prevalence of hypertension (similar to non-Hispanic whites), but a significantly higher prevalence of diabetes.” His findings contradict other recent studies that look at Hispanic people as one group, as is the case with current research that extrapolates low rates of hypertension among Hispanics of Mexican origin to all Hispanics to suggest that they are a population with low cardiovascular risk factors.
“Heterogeneity--reflecting racial diversity, differing national origins and lifestyle factors--among different Hispanic subgroups should be considered in the interpretation and application of cardiovascular epidemiologic studies within the literature and in future research,” Rodriguez said. “We should at least consider analysis of Hispanics by race and ethnic subgroup.”
Taking this new approach to heart disease research one step further, Rodriguez’s most recent study, to be completed this year, focuses on hypertension in the same groups. “Now, we are looking at 24-hour blood pressure and how it relates to LVH in the Hispanic population and if this relationship is affected by the racial diversity of the group. My goal is to continue this work to look at the ways that cultural, environmental and genetic variants influence cardiac risk,” he explained.
In addition to the discovery of significant heterogeneity throughout the Hispanic population, Rodriguez found that, “one of the other doors opened by this research is that we’re looking at how people from other cultures adapt to this culture and how that modifies cardiac structure such as LVH. Cardiac risk factors appear to increase when Hispanics come to America. In my practice, nearly 90 percent of my patients are Hispanic, so I am also looking at how different behaviors may contribute.”
“Being a part of the Harold Amos Program gave me the opportunity to conduct this research, but it has also changed the way I approach my projects. I now look at Hispanics as a population with significant heterogeneity among people from various parts of the world. Several colleagues have also told me that my research premise makes sense—that there are subsets among Hispanics that are likely as different from each other as the many other racial and ethnic groups in the United State are from each other,” Rodriguez said. “My Amos term ends in 2011, but this work will make it possible for me to learn what can be done to reduce cardiac risk in this population and other minority groups by gathering a clearer understanding of the ways that culture, race and ethnicity influence health.”
The Harold Amos Medical Faculty Development Program (AMFDP) was created to make it possible for scientists and physicians from historically disadvantaged backgrounds to advance to senior positions in academic medicine. The four-year, AMFDP, post-doctoral research awards are offered to physicians who are not only committed to building careers in academic medicine, but those who hope to serve as role models for other students and faculty members from disadvantaged backgrounds.