Largest comparison of cardiovascular risk profiles of Canada’s major ethnic groups

The ethnic group you belong to can determine what major cardiovascular risk factors you are most susceptible to. A comprehensive comparison of cardiovascular risk profiles of ethnic groups was conducted at the Institute for Clinical Evaluative Sciences (ICES) revealing important differences across Canada’s four largest ethnic groups. The study was funded by the Heart and Stroke Foundation of Ontario (HSFO).

"Although Canada is one of the most ethnically diverse countries in the world, relatively little is known about how Canada's four major ethnic groups differ in their cardiovascular risk profiles. To date, strategies for heart disease and stroke prevention have generally been ‘one-size-fits-all.’ However, the study shows ethnic groups living in Ontario differ strikingly in their risk factor profiles,” says Maria Chiu, principal investigator of the study, ICES Doctoral Fellow, University of Toronto PhD Candidate and Canada Graduate Scholar of the Canadian Institutes of Health Research (CIHR).

In 2006, the Heart and Stroke Foundation started initiatives to address unique cardiovascular needs of ethnic populations,” said Dr. Marco Di Buono, Director of Research, Heart and Stroke Foundation of Ontario. “Many of Canada’s ethno-cultural communities are at higher risk for heart disease and have unique linguistic and cultural challenges to overcome with respect to improving their heart health. We need to address these challenges to ensure the long-term heart health of all Canadians, including new immigrants coming to this country.”

People of South Asian, Chinese and Black ethnic background represent approximately 60 per cent of the world’s population, but our knowledge of cardiovascular risk has been derived mainly from studies conducted in White populations. There are nearly two million people of South Asian, Chinese or Black descent and more than 9 million people of European descent living in Ontario. An ethnically-tailored approach to screening and prevention might be more effective in reducing cardiovascular diseases in a multi-ethnic Canadian population. Specifically, the study highlights the key lifestyle changes that can be made by each ethnic group to reduce their risk of cardiovascular diseases.

The study of 154,653 Whites, 3,364 South Asians, 3,038 Chinese and 2,742 Blacks who represented people living in Ontario between 1996 and 2007 found:

• Two-fold higher risk of diabetes among the South Asian and Black groups than among the White and Chinese groups.
• The prevalence of hypertension was 44 per cent higher in the Black group and 24 per cent higher in the South Asian group as compared to the White group.
• Smoking prevalence was almost three times higher in the White group than in the Chinese and South Asian groups.
• Obesity was five times more prevalent in White and Black people than Chinese people.
• Overall, Chinese respondents had the most favourable cardiovascular risk factor profile, with 4.3 per cent of the population reporting two or more major cardiovascular risk factors (i.e. current smoking, obesity, diabetes, hypertension), followed by the South Asian (7.9 per cent), White (10.1 per cent) and Black (11.1 per cent) of respondents.
• Cardiovascular disease (heart disease or stroke) was almost twice as prevalent in South Asians as in Chinese.
• There is a Black paradox: Black people had a higher prevalence of most cardiovascular risk factors, but a lower prevalence of heart disease.
• Black females have higher prevalence of obesity, diabetes, hypertension and heart disease than Black males.
• Smoking was more common in men than women, but the difference between men and women was much smaller in the White and Black groups than in the Chinese and South Asian groups.
• 63-75 per cent of the study participants did not participate in at least 15 minutes of daily physical activity, and the problem was worst among South Asian men (70 per cent) and women (75 per cent), Chinese men (71 per cent) and women (75 per cent) and Black women (71 per cent).

“The findings have very important implications for the future of cardiovascular care in Canada, as the proportion of Canada’s population in visible minority groups increases over time. Health promotion experts, health system planners, and the general population need to be aware of these findings, so that they can target their cardiovascular risk prevention and treatment efforts most effectively,” says Jack Tu, senior author of the study, senior scientist at ICES, HSFO career investigator and staff cardiologist, Schulich Heart Centre, Sunnybrook Health Sciences Centre.

Author affiliations: ICES (Chiu, Austin, Manuel, Tu); Institute of Medical Science (Chiu, Tu) and the Dalla Lana School of Public Health (Austin, Manuel, Tu); Division of Cardiology, Schulich Heart Centre, Department of Medicine (Tu), Sunnybrook Health Sciences Centre; Ottawa Hospital Research Institute (Manuel); Statistics Canada (Manuel).

The study “Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996 and 2007.” is in the April 19, 2010 issue of CMAJ.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

The Heart and Stroke Foundation, a volunteer-based health charity, leads in eliminating heart disease and stroke and reducing their impact through the advancement of research and its application, the promotion of healthy living and advocacy. Data sources: Statistics Canada’s National Population Health Survey and Canadian Community Health Surveys. Funding Sources: Heart and Stroke Foundation of Ontario and Canadian Institutes of Health Research Canada Graduate Scholarship

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Deborah Creatura
• Media Advisor, ICES
• [email protected]
• 416-480-4780 or cell 647-406-5996