Advertisement

Immigration presents a potential increased risk for atherosclerosis

      Abstract

      Objective

      Immigrants in Western countries tend to have a greater risk for cardiovascular disease (CVD) than those in their home country, but it is unclear if immigrants are at increased risk for CVD compared to non-immigrants in their new country. The purpose of this study was to determine the independent association of time since immigration with sub-clinical atherosclerosis in immigrants of Chinese, European and South Asian origin.

      Methods

      A total of 460 immigrants and 158 non-immigrants of Chinese, European and South Asian origin without pre-diagnosed CVD were assessed for sub-clinical atherosclerosis by carotid artery ultrasound scan, socio-demographics, CVD risk factors and lifestyle factors. Time since immigration in years was used as a measure of exposure.

      Results

      Participants who immigrated ≥30 years ago had a greater intima-media thickness (IMT) of the carotid artery compared to non-immigrants, and immigrants of ≤20 years. Time since immigration was associated with IMT, plaque area and IMT + plaque area. After adjustment for age, sex, ethnicity, income, education, family history of CVD and diabetes, smoking, physical activity, body mass index, visceral adipose tissue, lipids, insulin, glucose and blood pressure, time since immigration was significantly associated with IMT. For every ten years since immigration there was a 2% increase in IMT in addition to the 7% increase for every 10 years of age.

      Conclusions

      Immigration was associated with an increased burden of sub-clinical atherosclerosis that surpassed that of non-immigrants. This burden increased over time independent of other risk factors. Immigrants represent a high-risk group for which targeted interventions are needed.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Statistics Canada. 2006 Census: Immigration, citizenship, language, mobility and migration. Ottawa: Statistics Canada; December 4, 2007.

        • MaloneF N.
        • Baluja KF.
        • Costanzo JM.
        • Davis CJ.
        The foreign-born population: 2000.
        US Census Bureau, Washington2003
      2. National Statistics. Foreign-born: 1 in 12 in UK born overseas; 2005 (accessed April 26, 2008), at http://www.statistics.gov.uk/CCI/nugget.asp?ID=1312&Pos=1&ColRank=2&Rank=768.

        • Yusuf S.
        • Reddy S.
        • Ounpuu S.
        • Anand S.
        Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization.
        Circulation. 2001; 104: 2746-2753
        • Yusuf S.
        • Reddy S.
        • Ounpuu S.
        • Anand S.
        Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies.
        Circulation. 2001; 104: 2855-2864
        • Marmot M.G.
        • Syme S.L.
        • Kagan A.
        • Kato H.
        • Cohen J.B.
        • Belsky J.
        Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of coronary and hypertensive heart disease and associated risk factors.
        Am J Epidemiol. 1975; 102: 514-525
        • Lauderdale D.S.
        • Rathouz P.J.
        Body mass index in a US national sample of Asian Americans: effects of nativity, years since immigration and socioeconomic status.
        Int J Obes Relat Metab Disord. 2000; 24: 1188-1194
        • Lee M.M.
        • Wu-Williams A.
        • Whittemore A.S.
        • et al.
        Comparison of dietary habits, physical activity and body size among Chinese in North America and China.
        Int J Epidemiol. 1994; 23: 984-990
        • Koya D.L.
        • Egede L.E.
        Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants.
        J Gen Intern Med. 2007; 22: 841-846
        • Moran A.
        • Roux A.V.
        • Jackson S.A.
        • et al.
        Acculturation is associated with hypertension in a multiethnic sample.
        Am J Hypertens. 2007; 20: 354-363
        • Goel M.S.
        • McCarthy E.P.
        • Phillips R.S.
        • Wee C.C.
        Obesity among US immigrant subgroups by duration of residence.
        JAMA. 2004; 292: 2860-2867
        • Tremblay M.S.
        • Perez C.E.
        • Ardern C.I.
        • Byran S.N.
        • Katzmarzyk P.T.
        Obesity, overweight and ethnicity.
        Health Reports. 2005; 16: 23-34
        • Diez Roux A.V.
        • Detrano R.
        • Jackson S.
        • et al.
        Acculturation and socioeconomic position as predictors of coronary calcification in a multiethnic sample.
        Circulation. 2005; 112: 1557-1565
        • Mooteri S.N.
        • Petersen F.
        • Dagubati R.
        • Pai R.G.
        Duration of residence in the United States as a new risk factor for coronary artery disease (The Konkani Heart Study).
        Am J Cardiol. 2004; 93: 359-361
        • Rubia M.
        • Marcos I.
        • Muennig P.A.
        Increased risk of heart disease and stroke among foreign-born females residing in the United States.
        Am J Prev Med. 2002; 22: 30-35
        • Lear S.A.
        • Birmingham C.L.
        • Chockalingam A.
        • Humphries K.H.
        Study Design of the Multicultural Community Health Assessment Trial (M-CHAT)—a comparison of body fat distribution in four distinct populations.
        Ethnic Disord. 2006; 16: 96-100
      3. The EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 1990;16(3):199–208.

        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Aminbakhsh A.
        • Frohlich J.
        • Mancini G.B.
        Detection of early atherosclerosis with B mode carotid ultrasonography: assessment of a new quantitative approach.
        Clin Invest Med. 1999; 22: 265-274
        • Lear S.A.
        • Humphries K.H.
        • Kohli S.
        • Frohlich J.J.
        • Birmingham C.L.
        • Mancini G.B.
        Visceral adipose tissue, a potential risk factor for carotid atherosclerosis: results of the Multicultural Community Health Assessment Trial (M-CHAT).
        Stroke. 2007; 38: 2422-2429
        • Lear S.A.
        • Humphries K.H.
        • Kohli S.
        • Chockalingam A.
        • Frohlich J.J.
        • Birmingham C.L.
        Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT).
        Am J Clin Nutr. 2007; 86: 353-359
        • Jang Y.
        • Kim G.
        • Chiriboga D.A.
        Correlates of sense of control among older Korean–American immigrants: Financial status, physical health constraints, and environmental challenges.
        Int J Aging Hum Dev. 2006; 63: 173-186
        • Aycan Z.
        • Berry J.W.
        Impact of employment-related experiences on immigrants’ psychological well-being and adaptation to Canada.
        Can J Behav Sci. 1996; 28: 240-251
        • Rosengren A.
        • Hawken S.
        • Ounpuu S.
        • et al.
        Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case–control study.
        Lancet. 2004; 364: 953-962
        • Mackenbach J.P.
        • Stirbu I.
        • Roskam A.J.
        • et al.
        Socioeconomic inequalities in health in 22 European countries.
        N Engl J Med. 2008; 358: 2468-2481
        • Bowen S.
        Access to health services for underserved populations in Canada.
        in: Canada H. Certain circumstances: issues in equity and responsiveness in access to health care in Canada. Health Canada, Ottawa2000: 1-60
        • Gadd M.
        • Johansson S.E.
        • Sundquist J.
        • Wandell P.
        The trend of cardiovascular disease in immigrants in Sweden.
        Eur J Epidemiol. 2005; 20: 755-760
        • Renzaho A.M.
        • Swinburn B.
        • Burns C.
        Maintenance of traditional cultural orientation is associated with lower rates of obesity and sedentary behaviours among African migrant children to Australia.
        Int J Obes (Lond). 2008; 32: 594-600
        • Shelley D.
        • Fahs M.
        • Scheinmann R.
        • Swain S.
        • Qu J.
        • Burton D.
        Acculturation and tobacco use among Chinese Americans.
        Am J Public Health. 2004; 94: 300-307
        • Mathers C.D.
        • Sadana R.
        • Salomon J.A.
        • Murray C.J.
        • Lopez A.D.
        Healthy life expectancy in 191 countries, 1999.
        Lancet. 2001; 357: 1685-1691
        • Halbert J.A.
        • Silagy C.A.
        • Finucane P.
        • Withers R.T.
        • Hamdorf P.A.
        Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials.
        Eur J Clin Nutr. 1999; 53: 514-522
        • Zureik M.
        • Touboul P.J.
        • Bonithon-Kopp C.
        • Courbon D.
        • Ruelland I.
        • Ducimetiere P.
        Differential association of common carotid intima-media thickness and carotid atherosclerotic plaques with parental history of premature death from coronary heart disease: the EVA study.
        Arterioscler Thromb Vasc Biol. 1999; 19: 366-371