Abstract Body (Do not enter title and authors here): Background: Asians are the fastest-growing population in the United States (US). Cardiovascular disease (CVD) remains the leading cause of disability and death among persons of Asian heritage in the US. Certain groups of Asian heritage may be at disproportionately high risk of CVD and all-cause death.

Hypothesis: We hypothesize that there is heterogeneity in CVD and all-cause death among disaggregated Asian heritage groups (Chinese, Filipino, and Asian Indian, and others) based on nativity status (US- vs Foreign-born).

Methods: The study analyzed pooled data from the 1999-2018 National Health Interview Survey linked with the National Death Index. The outcomes were CVD death (disease of heart and cerebrovascular disease deaths, based on ICD-10) and all-cause death, in years, derived from the time of interview to the year of death or December 31, 2019 (last date of follow-up). Survey-weighted Cox regression models were used to explore differences in CVD and all-cause death among Asian heritage groups, controlling for covariates (age, sex, marital status, poverty-income ratio, and education).

Results: The study included 37,104 Asian adults (21.8% Chinese, 33.5% Filipino, and 44.6% Asian Indians and others). Over a median follow-up of 11 years (Interquartile range: 7-15), there were 1.7 CVD deaths and 5.6 all-cause deaths per 1,000 person-years. The fully adjusted model revealed a 33% lower CVD death hazard among foreign-born Filipino adults (Hazard Ratio [HR]: 0.67; 95% Confidence Interval [CI]: 0.49–0.91) compared to their US-born counterparts. Similarly, for all-cause death, foreign-born Asian Indians exhibited a 40% lower hazard (HR: 0.60; 95% CI: 0.48-0.74), and Filipinos showed a 33% lower hazard (HR: 0.67; 95% CI: 0.51-0.88) when compared to their US-born counterparts.

Conclusion: There was heterogeneity in CVD and all-cause death among Asian heritage groups. Overall, CVD and all-cause death were lower among foreign- than US-born adults specifically among Filipino and Asian Indian and others. These findings warrant the targeted implementation of evidence-based approaches to CVD prevention and promotion.