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Type 2 diabetes and atherosclerotic CVD risk varies considerably among Asian American subgroups and clinical trials assessing interventions must reflect the disparities within the Asian American population, researchers reported.

The prevalence of type 2 diabetes and stroke mortality is higher among all Asian American subgroups compared with white adults, whereas data show ASCVD risk is highest among South Asian and Filipino adults but lowest among Chinese, Japanese and Korean adults, according to a new scientific statement from the American Heart Association. The statement highlights the biological pathway of type 2 diabetes and the possible role of genetics in type 2 diabetes and ASCVD in Asian adults. The researchers noted that there are challenges to providing evidence-based recommendations because trials often do not reflect the diverse population.

Asian American individuals make up the fastest growing ethnic group in the United States, Tak W. Kwan, MD, FAHA, chief of cardiology at Lenox Health Greenwich Village/Northwell Health and clinical professor of medicine (cardiology) at the Zucker School of Medicine at Hofstra/Northwell, told Healio. Type 2 diabetes is a major risk factor for atherosclerotic CVD. Together, type 2 diabetes and atherosclerotic CVD are the leading causes of mortality and morbidity among Asian American adults. Nevertheless, significant variability in type 2 diabetes and atherosclerotic CVD prevalence and risk factors exists within the different subgroups of Asian American people. Most literature aggregates Asian American subgroups into a single racial and ethnic group and fails to distinguish Asian American subgroups individually, which may mask type 2 diabetes and ASCVD disparities that exist between these different subgroups.

Subgroups are broadly categorized by the geographic region of Asian descent and include South Asia (India, Pakistan, Sri Lanka, Bangladesh, Nepal or Bhutan); East Asia (Japan, China or Korea); Southeast Asia (Philippines, Vietnam, Thailand, Cambodia, Laos, Indonesia, Malaysia, Singapore, Hmong); and Native Hawaiian/Pacific Islander (Hawaii, Guam, Samoa or other Pacific islands).

The scientific statement summarized current literature on the demographics and biological and social mechanisms that contribute to type 2 diabetes and ASCVD among Asian American adults and examines acculturation in the context of culturally appropriate strategies in the prevention and management among this diverse ethnic group, Kwan said.

Tak W. Kwan

This scientific statement provides individual and community-level intervention suggestions for health care professionals who interact with the Asian American population, Kwan said. Cardiologists and community-based efforts can have the potential to educate Asian Americans and the immigrant population on the health/risk behaviors associated CV health.

The statement notes that the highest rate of CAD was among Asian Indian Americans, with rates of 13% for men and 4.4% for women, followed by Filipino Americans (9.2% for men and 4% for women), Chinese Americans (6.4% for men and 2.5% for women), Japanese Americans (6.9% for men and 2.7% for women) and Korean Americans (5.9% for men and 1.7% for women).

Central to these efforts are consideration of family characteristics, social networks, and community resources and supports, Kwan told Healio. Asian American patients and health care professionals should be encouraged to use resources such as the joint AHA/American Diabetes Association initiative Know Diabetes by Heart, for which significant clinical updates are provided for controlling BP, lipids and glucose to reduce ASCVD risk in patients with type 2 diabetes.

Because of the high incidence and prevalence of type 2 diabetes among Asian American adults, Kwan said there is an urgent need for specific physiological studies and long-term, prospective, randomized controlled trials that include participants from varying Asian American subgroups to demonstrate the safety and efficacy of interventions.

Future studies of ASCVD risk in Asian American adults also need to be adequately powered, to incorporate multiple Asian ancestries and include multigenerational cohorts, Kwan told Healio. With advances in epidemiology and data analysis and the availability of larger, representative cohorts, further refining the pooled cohort equations, in addition to enhancers, would allow better risk estimation in segments of the population, including underrepresented racial and ethnic groups and those with social deprivation, and may allow more targeted risk assessment within diverse racial and ethnic groups.

Tak W. Kwan, MD, FAHA, can be reached at tkwan@northwell.edu; Twitter: kwancardio.

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