Lipid patterns among foreign and U.S. born patients in a medical group
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Background: Elevated triglycerides and low HDL-cholesterol are components of the cardiometabolic syndrome (CMS). Even though the prevalence of CMS among foreign born (FB) is twice that of the US born population, and cardiovascular mortality among FB residents of the US with CMS is high, it is not known whether the lipids of the foreign born have a cardiometabolic pattern. Our objective is to describe the lipid patterns of FB patients of a medical group and compare them to the lipid patterns of US born patients.
Methods: We conducted a retrospective medical record review of US and FB HealthPartners Medical Group patients who were 20+ years old and had outpatient LDL, HDL, triglycerides, and total serum cholesterol levels assessed in 2010. Place of birth was ascertained using country of origin and primary language. FB patients were classified into the following subgroupings: developed regions, Sub-Saharan Africa, Eastern Asia, Southern Asia, South-Eastern Asia, and Latin America. Demographic characteristics and risk factors are described using frequency distributions. Association of place of birth with dyslipidemia is presented as adjusted odds ratio using logistic regression analyses.
Results: The data set comprises the records of 53,361 (89%) US born and 6,430 (11%) FB patients. The prevalence of CMS in US born was 39% and 31% for FB patients. The prevalence of high LDL cholesterol (27% US vs 30% FB), high TG (34% US vs 33% FB), low HDL cholesterol (36% US vs 39% FB), and high total cholesterol (38% US vs 38% FB). FB and US born differ in several risk factors such as age, smoking, BMI, insurance coverage, and statin use. Large heterogeneity of lipid pattern was observed across the countries of origin of FB patients with higher percentage of having low HDL levels among women of Somali (49%), Hmong (51%), Sub-Sarahan Africa (45%), Southern Asian (59%) and Latin American (49%) origin. After adjusting for potential confounding, association of country of origin with lipid abnormality was observed for low HDL-cholesterol (1.34 OR, CI 1.23-1.45), high LDL cholesterol (1.11 OR, CI 1-02-1.21), and high TG (1.11 OR, CI 1.02-1.22). FB and US born patients with CVD who are treated with statin is 76.6% and 79.8% respectively.
Conclusion: The prevalence of heterogeneity of dyslipidemia across population groups in FB patients is large. The rate of CMS was no different between FB and US born, however, lipid abnormalities were greater among FB patients. Awareness of lipid abnormalities, especially in this group, designates cardiometabolic dyslipidemia as an important target of lipid lowering therapy. In addition, nativity status is a non-modifiable characteristic that can be considered as an important variable in stratifying risk for cardiovascular disease.