By Michael H. Crawford, MD, Editor
Synopsis: An analysis of a Centers for Disease Control and Prevention database has shown the cardiovascular disease mortality rate is higher in Asian Americans than in non-Asian Americans and that this excess mortality is particularly prevalent in Filipino Americans.
Source: Aggarwal R, Wadhera, RK, Chiu N, et al. Cardiovascular risk factor and disease mortality among Asian Indian, Chinese, and Filipino adults in the United States, 2018 to 2023. Ann Intern Med. 2025; Jul 29. doi: 10.7326/ANNALS-25-00108. [Online ahead of print].
Certain Asian subpopulations (e.g., Asian Indians) in the United States are known to be at higher risk of cardiovascular disease. Since Asian Americans are the fastest-growing racial/ethnic group in the United States, it would be useful to have more granular data on specific U.S. Asian subpopulations. Thus, this report from authors in Boston, New York, and Denver is of interest.
The investigators interrogated data from the Centers for Disease Control and Prevention’s WONDER database from 2018 to 2023 to assess cardiovascular disease (CVD) risk factors and mortality in Asian Indians, Chinese, and Filipino American subgroups in the United States. WONDER contains death certificate data for all U.S. residents. Adults aged 18 years or older who were identified as Asian Indian, Chinese, or Filipino were included. Those identified as multiracial from these three groups were excluded.
The cause of death was taken from the International Classification of Diseases 10th Revision codes, including all-cause, cardiovascular, heart disease, stroke, diabetes, and hypertension. Age-standardized mortality rates (ASMRs) as deaths per 100,000 population were determined by sex-specific age adjustment to the 2023 American Community Survey population estimates. Overall, CVD ASMRs were highest for Filipino American women (176/100,000; 95% confidence interval [CI], 173 to 178) and men (248/100,000; 95% CI, 244 to 252). Asian Indian Americans were next highest (158/100,000 for women; 95% CI, 154 to 161 and 184/100,000 for men; 95% CI, 181 to 187). Chinese Americans were slightly lower at 155/100,000 for women (95% CI, 153 to 158) and 170/100,000 for men (95% CI, 168 to 172). The authors concluded that Asian Indian, Chinese, and Filipino Americans have relatively high rates of CVD mortality and that targeted public health interventions are necessary to reduce this high death rate.
Commentary
The current atherosclerosis CVD risk calculators do not account for this excess mortality in Asian Americans. Not only are they not race/ethnicity-adjusted, but they ignore family history, which would pick up much of this excess risk. However, other risk factors also are known to be higher in Asian Americans. Asian Indian Americans have a high rate of diabetes and Chinese Americans have high rates of hypertension. Filipino Americans have a high rate of both hypertension and diabetes, which may explain their worse prognosis.
Presumably, earlier detection of risk factors and CVD in these populations could improve mortality, but this presents its own challenges. Many Asian Americans are immigrants, which creates unique heathcare access issues. Often these patients are not seen by healthcare systems until they have an adverse CVD event. After a stroke or myocardial infarction has occurred, the opportunity for prevention is gone.
There are limitations to this study to consider. There are no socioeconomic data available. Lifestyle is not considered, nor is access to care. The cause of death was determined from billing codes and may not tell the whole story. Also, COVID-19 affected mortality rates during the time period of the study and may have precipitated CVD deaths. Finally, other Asian American groups, such as Japanese, Vietnamese, and Koreans, were not studied.
Many physicians appreciate that Asian Indian Americans have a high incidence of atherosclerotic coronary artery disease, since several studies have reported on this. Also, the proclivity of Chinese Americans for stroke is well known. What I believe is unique in this study is the much higher rate of all CVD in Filipino Americans compared to the other two groups.
Michael H. Crawford, MD, is Professor Emeritus of Medicine and Consulting Cardiologist, UCSF Health, San Francisco.
