Racial and Ethnic Differences in the Health of Older Americans (1997) / Chapter Skim
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9 Cardiovascular Disease Among Elderly Asian Americans
9 Cardiovascular Disease Among Elderly Asian Americans
Pages 270-284
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From page 270... ...
Most of them prospered, sent for wives, and established permanent residences. The importance of this situation became apparent in the late 1950s when international comparisons of mortality rates from coronary heart disease showed that Japanese in Japan had among the lowest rates in the world and that Japanese in Hawaii and California had rates that were two and three times higher (Gordon, 1957)
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From page 271... ...
to verify the reported differences among Japanese men in the three geographic locations by comparing prevalence of, incidence of, and mortality from coronary heart disease measured the same way, and (2) to search for the factors that could explain the observed differences.
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From page 272... ...
The values recorded at this baseline examination were used as risk factor levels throughout the present report unless otherwise noted. Measures of Acculturation for the Hawaii Cohort The variables used in this study as measures of the degree of exposure to Japanese culture include birthplace (mainly Japan or Hawaii)
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From page 273... ...
Definition of Cases The prevalence of coronary heart disease at the initial Ni-Hon-San examination included definite and probable myocardial infarction diagnosed by electrocardiogram findings and angina pectoris diagnosed by the World Health Organization standard questionnaire. The incidence of cases among men without any clinical coronary heart disease at baseline was classified by the worst level of disease.
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From page 274... ...
Only those cases with a diagnosis agreed upon by physicians of both groups were accepted for the study. For analyses of the association of risk factors upon the incidence of coronary heart disease within the Hawaii cohort, total coronary heart disease, subgroups of fatal coronary heart disease, nonfatal myocardial infarction, and angina pectoris were used.
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From page 275... ...
In contrast, percentages of total calories derived from carbohydrates, especially complex carbohydrates, and alcohol were significantly greater in Japan than in Hawaii and California. Table 9-4 shows age-adjusted prevalence rates per 1,000 men of definite or TABLE 9-2 Age-Adjusted Means and Percentages of Selected Variables at Baseline Examination for the Ni-Hon-San Study Variable Japan Hawaii California Body mass index (kg/m2)
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From page 276... ...
Studies comparing the incidence of coronary heart disease among the NiHon-San Study cohorts found that the major risk factors predicted the risk of coronary heart disease in a generally consistent way in all cohorts, and that the differences in the incidence of or mortality from coronary heart disease could be largely explained by the differences in the levels of known risk factors among indigenous Japanese men and among men of Japanese ancestry living in the United States (Robertson et al., 1977; Yano et al., 1988~. For example, in regression of the incidence of coronary heart disease, the effects on baseline serum cholesterol were the same in Japan and Hawaii, but the distribution of serum cholesterol was much higher in Hawaii.
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From page 277... ...
All of these risk factors were statistically significant for these older men, and the strength of the associations were similar to those found for m~ddle-aged men (Benfante et al., 1989; Benfante and Reed, 1990; Reed and Benfante, 1992~. Having verified the importance of the biological risk factors for coronary heart disease among these Japanese men, we proceeded to examine the cultural experiences that might further our understanding of the international differences.
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From page 278... ...
, all aged 55 to 68 at the initial examination. As Table 96 shows, the Issei men born in Japan had significantly lower levels of all major risk factors for coronary heart disease except for serum glucose and cigarettepack years.
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From page 279... ...
There were no differences in socioeconomic status among these groups. When each acculturation score was included in multiple logistic models that also included the major biological risk factors, none of the acculturation scores were associated with any clinical measure of coronary heart disease (Reed et al., 1982~.
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From page 280... ...
Measures of social support networks were inversely associated in bivariate analyses with age, but in multivariate models that included the main risk factors, the associations were not statistically significant (Reed et al., 1983~. Furthermore, there were no TABLE 9-8 Age-Adjusted Mean Values of Selected Risk Factors by Quartiles of the Total Acculturation Score Quartilesa Risk Factors 1 2 3 4 Systolic blood pressure (mm Hg)
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From page 281... ...
there is a twofold to threefold higher risk of coronary heart disease among Japanese men in the United States compared with Japanese men in Japan, and (2) this difference can be accounted for largely by differences in the major risk factors, especially serum cholesterol, serum glucose, blood pressure, smoking, and alcohol intake.
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From page 282... ...
All support the concept that differences in the occurrence of coronary heart disease are due mainly to specific behavioral and lifestyle characteristics that are influenced by social and cultural standards. Modification of high-risk behavior offers the clearest and most effective way to prevent cardiovascular disease and the resulting physical disability in the elderly.
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From page 283... ...
MacLean, and K Yano 1989 Risk factors in middle age that predict early and late onset of coronary heart disease.
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From page 284... ...
Belsky 1975 Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: Prevalence of coronary and hypertensive heart disease and associated risk factors. American Journal of Epidemiology 102:514-525.
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