As part of the Boricua Youth Study – Health Assessment study, which examines the cardiovascular health of Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY, we recently published on the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among this population.
The BYS-HA study conducted home visits to collect objective anthropometric, blood pressure and blood samples when participants were on average 23 years of age. Information on diet, physical activity and sleep were collected via surveys. In addition to calculating measures of obesity, diabetes and hypertension we also calculated a measure of ideal cardiovascular Health (CVH). We utilized the American Heart Association, Life’s Essential 8 metric which includes 8 markers of cardiovascular health: adequate sleep, healthy diet, physical activity, no tobacco exposure, blood pressure, weight status, diabetes and lipids. We characterized CVH scores as continuous with higher scores indicating more optimal CVH and categorically (80-100 scores for ideal CVH). We examined different prevalence of cardiometabolic risk factors and CVH by site (NY vs PR) and by sex.
In this sample of 759 participants, 413 of the participants lived in Puerto Rico with 346 in the South Bronx NY. The mean age of participants was 22.6 years and 50% were female. Twenty-seven percent of the sample received public assistance in young adulthood. Overall, there was a high prevalence of obesity and high HBA1C (≥5.7, a measure of diabetes risk) with noted differences across study site. Participants in NY had a higher prevalence of obesity (35% in NY and 19% in PR) and hypertension (8% in NY and 2% in PR). Across both sites, men had a higher prevalence of hypertension, but women had a higher prevalence of obesity and low total cholesterol compared to men. In both NY and PR, women had better blood pressure and lipids but lower physical activity compared to men. In PR, women also had better diet and nicotine exposure scores compared to men.
Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion.
Our findings suggest sociocultural factors can influence cardiometabolic health measures. Overall, 4 of the 7 metrics examined were worse in the NY population compared to PR. In PR, measures of diet and PA were worse compared to the NY site. While study participants are ethnically homogenous, Puerto Ricans living in NY are considered and ethnic minority while those living in Puerto Rico are the ethnic majority, experiences of discrimination and racism may differ across groups. Furthermore, BYS participants live in distinct social, political, cultural and built environments. Differences between sites based on access to food, recreational facilities and walkability of neighborhoods could explain noted cardiometabolic differences. Similarly social, political, and cultural factors, including economic and political instability, structural racism, adequate health care access and educational and occupational opportunities differ across sites. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease.
https://www.sciencedirect.com/science/article/abs/pii/S1047279723002144