Eamranond Pracha P, Legedza Anna T R, Diez-Roux Ana V, Kandula Namratha R, Palmas Walter, Siscovick David S, Mukamal Kenneth J
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Am Heart J. 2009 Jan;157(1):53-9. doi: 10.1016/j.ahj.2008.08.015.
The association of acculturation and cardiovascular risk factor control among populations with high proportions of immigrants has not been well studied.
We studied 1,492 Hispanic participants in the Multi-Ethnic Study of Atherosclerosis (MESA) with hypertension, hypercholesterolemia, and/or diabetes. We used linear regression to examine the cross-sectional relationships between acculturation measures and cardiovascular risk factor levels. Outcome measures included systolic blood pressure (mm Hg), fasting low-density lipoprotein (LDL) cholesterol (mg/dL), and fasting blood glucose (mg/dL). Covariates included education, income, health insurance, physical activity, dietary factors, risk factor-specific medication use, duration of medication use, smoking, and body mass index.
There were 580 Hispanics with hypertension, 539 with hypercholesterolemia, and 248 with diabetes. After adjustment for age and gender, Spanish-speaking Hispanics with cardiovascular risk factors had higher systolic blood pressure, fasting LDL cholesterol, and fasting blood glucose compared to English-speaking Hispanics. Differences in systolic blood pressure were accounted for mainly by education, whereas differences in LDL cholesterol were almost entirely accounted for by cholesterol-lowering medication use. Differences in fasting glucose were partly accounted for by socioeconomic variables but were augmented after adjustment for dietary factors. Similar associations were observed between proportion of life in the United States and risk factor levels.
Among those with cardiovascular risk factors, Hispanics who spoke Spanish at home and lived less time in the United States had worse control of cardiovascular risk factors. Treatment strategies that focus on Hispanics with low levels of acculturation may improve cardiovascular risk factor control.
在移民比例较高的人群中，文化适应与心血管危险因素控制之间的关联尚未得到充分研究。
我们在多族裔动脉粥样硬化研究（MESA）中对1492名患有高血压、高胆固醇血症和/或糖尿病的西班牙裔参与者进行了研究。我们使用线性回归来检验文化适应指标与心血管危险因素水平之间的横断面关系。结局指标包括收缩压（毫米汞柱）、空腹低密度脂蛋白（LDL）胆固醇（毫克/分升）和空腹血糖（毫克/分升）。协变量包括教育程度、收入、医疗保险、身体活动、饮食因素、危险因素特异性药物使用、用药时长、吸烟和体重指数。
有580名西班牙裔患有高血压，539名患有高胆固醇血症，248名患有糖尿病。在对年龄和性别进行调整后，与说英语的西班牙裔相比，患有心血管危险因素的说西班牙语的西班牙裔收缩压、空腹LDL胆固醇和空腹血糖更高。收缩压的差异主要由教育程度造成，而LDL胆固醇的差异几乎完全由降胆固醇药物的使用造成。空腹血糖的差异部分由社会经济变量造成，但在对饮食因素进行调整后有所增加。在美国生活的时间比例与危险因素水平之间也观察到了类似的关联。
在患有心血管危险因素的人群中，在家说西班牙语且在美国生活时间较短的西班牙裔对心血管危险因素的控制较差。针对文化适应程度较低的西班牙裔的治疗策略可能会改善心血管危险因素的控制。
