Abstract Body: Introduction: Atherosclerotic cardiovascular disease (ASCVD) risk varies substantially across racial and ethnic groups, yet few data exist among disaggregated Asian American, Native Hawaiian, and Pacific Islander (AANHPI) subgroups.
Methods: We identified 2,653,007 members of Kaiser Permanente Northern California and Kaiser Permanente Hawaii integrated healthcare delivery systems from 2012-2022 who were aged ≥30 years with no evidence of prior cardiovascular disease. ASCVD events (acute myocardial infarction and stroke) were identified through December 2023 using validated discharge codes and death certificates. We calculated age- and sex-adjusted rates of incident ASCVD by racial/ethnic subgroup. We then examined the multivariable association between AANHPI subgroup with incident ASCVD compared to non-Hispanic White, after adjustment for age, sex, diabetes, hypertension, dyslipidemia, chronic kidney disease, body mass index, and tobacco use.
Results: Between 2012-2022, we identified 182,776 Chinese, 193,327 Filipino, 64,488 Native Hawaiian/other Pacific Islander, 45,502 Japanese, 21,989 Korean, 92,738 South Asian, 50,141 Vietnamese, 26,602 other Southeast Asian, and 1,975,444 non-Hispanic White eligible adults. Mean (SD) age was 49 (15) years overall, ranging from 41 (12) years in South Asian to 55 (16) years in Japanese, with 53% women and higher proportions of women in AANHPI subgroups compared to non-Hispanic Whites. Age- and sex-adjusted rates (per 1000 person-years) of incident ASCVD vs. non-Hispanic Whites (3.61) from highest to lowest in AANHPI subgroups were: Native Hawaiian/other Pacific Islander (6.97), other Southeast Asian (5.37), South Asian (4.85), Filipino (4.23), Vietnamese (3.28), Japanese (3.20), and Chinese (2.50). After adjustment for traditional mediators of cardiovascular risk, compared to non-Hispanic Whites, incident ASCVD was higher for Native Hawaiian/other Pacific Islanders, South Asians, and other Southeast Asians; lower for Chinese, Japanese and Korean; and not significantly different for Filipino and Vietnamese (Figure).
Conclusions: In a large, contemporary population in California and Hawaii, notable variation existed in the risk of incident ASCVD across AANHPI subgroups that was only partially explained by differences in demographic characteristics and clinical ASCVD risk factors. Delineating AANHPI-specific factors will help to reduce disparities in ASCVD in these growing populations within the U.S.