Background:
Hispanics are the fastest‐growing segment of the U.S. population. An observation that Hispanics have lower all‐cause cardiovascular morbidity and mortality despite increased risk factor rates has been termed the “Hispanic paradox.” The Framingham Heart Study produced a coronary heart disease (CHD) prediction equation for assessing risk in a predominantly white population; consequently concerns arose about generalizations to other populations. We aimed to evaluate the prediction accuracy of the Framingham cardiac risk equation for Hispanics and to assess the Hispanic paradox.
Methods:
In a total of 200 patients we used the Framingham cardiac risk index (FCRI) as a prediction model to compare Hispanics and whites. We compared the FCRI in 100 Hispanic and white patients matched for ethnicity and age with acute coronary syndrome (ACS) as the primary end point, assessing their risk. In the second part of our study 100 patients matched for age, diabetes mellitus, socioeconomic status, and absence of baseline CHD were assessed for their cardiac risk in the present and also in the past 3‐5 years using medical records. The distribution of the FCRI between these 2 ethnic groups was compared.
Results:
One hundred ACS patients (male:female = 61:39, white:Hispanic = 50:50) were analyzed using the independent‐sample t test (SPSS 14), with statistical significance set at P < 0.05. Mean Framingham risk scores were 16.1 ± 8.4 for whites and 20 ± 12.6 for Hispanics. The results revealed no statistically significant racial difference (P =0.07). One hundred non‐CHD patients were analyzed (male:female = 33:67, white:Hispanic = 50:50). With repeated‐measures ANOVA (SPSS 14), Framingham risk scores among whites and Hispanics were analyzed at 2 points separated by 3‐5 years. A P value < 0.05 was considered statistically significant. Results revealed no statistically significant difference in past versus present cardiac risk score by race (P = 0.62). Mean past risk scores were 11.2 ± 6.4 for whites and 11.3 ± 6.7 for Hispanics. Mean present risk scores were 11.9 ± 6.1 for whites and 12. ± 7.1 for Hispanics.
Conclusions:
The Framingham cardiac risk equation predicted ACS with similar efficiency among whites and Hispanics. The distribution of Framingham cardiac risk scores is equivalent among both white and Hispanic non‐CHD patients. Both the risk scores and progression of disease risk were comparable at 2 discrete points spanning 3‐5 years. These findings imply that Hispanics have a similar cardiovascular risk profile and end point as whites. The observation of a Hispanic paradox was not identified, and as such a calibration factor is not recommended. Aggressive risk‐reduction strategies should be similar for whites and Hispanics.
Author Disclosure:
J. Pamula, none; S. Nanda, none.