Coronary heart disease in Filipino and Filipino-American patients: prevalence of risk factors and outcomes of treatment.
BACKGROUND
Very little has been published on Filipino (F) or Filipino-American (FA) health. Nothing has been written about coronary risk factors and their relationship to outcomes of percutaneous coronary intervention or cardiac surgical treatment in this group. The purpose of this study was to analyze prospectively collected data at a center treating coronary artery disease in a large series of Filipino patients.


METHODS
From January 1, 1992 to December 1, 1996, 527 consecutive FA patients and 3,176 Caucasians (C) were identified from an ongoing cardiac database. In-hospital and late outcomes post discharge were evaluated and results between the FA and C groups were compared.


RESULTS
The FA population had a higher incidence of hypertension (79% vs. 61%, p < 0.0001) and diabetes (34.7% vs. 24.1%, p < 0.001) compared to C patients. Hypercholesterolemia was similar in both groups. Obesity (FA 12.2% vs. C 18.3%, p < 0.0001) and current smoking (FA 15.8% vs. C 21.5%, p < 0.001) were more common in the C patients. Age at presentation did not differ between groups. Morbidity and mortality were higher in the FA patients following intervention in the catheterization lab (4.2% vs. 1.3%, p < 0.01). Logistic regression showed that FA ethnicity was an independent predictor of death after catheterization laboratory intervention (p < 0.01), along with emergency procedure, depressed ejection fraction, history of myocardial infarction (MI) and age greater than 65. For coronary bypass surgery, mortality and rate of MI was similar in both groups. Late follow-up post discharge (mean 17 months, range 12Eth 68) was obtained on 90% and 89% of eligible FA and C patients, respectively. Occurrence of late death and MI did not differ between the groups. However, need for any reintervention (catheterization laboratory or surgical) was significantly higher in the FA patients (21.2% vs. 14. 9%, p < 0.001). Cox proportional hazard regression modeling showed that FA ethnicity was an independent predictor of need for late reintervention (p < 0.01), along with type of initial treatment, history of diabetes, presence of triple vessel disease, initial presentation with acute MI and age greater than 65.


CONCLUSIONS
Filipino-Americans have a higher prevalence of hypertension and diabetes, and a lower prevalence of smoking and obesity compared to Caucasians. FA ethnicity is an independent predictor of higher mortality after catheterization laboratory intervention and increased need for late reintervention. However, the rate of late MI and death in FA was similar to C patients. These results suggest that FA patients, especially those presenting with diabetes for CAD treatment, need to be followed closely after percutaneous intervention or cardiac surgery procedures.
Ryan
C
C
San Francisco Heart Institute, Seton Medical Center, 1900 Sullivan Avenue, Daly City, CA, 94015, USA. c4ryan@chw.edu.
Shaw
R
R
Pliam
M
M
Zapolanski
A J
AJ
Murphy
M
M
Valle
H V
HV
Myler
R
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002140:California / Q000453:epidemiology; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D010679:Philippines / Q000208:ethnology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People