title: Association between language and risk factor levels among Hispanic adults with hypertension, hypercholesterolemia, or diabetes.
abstract: BACKGROUND
  The association of acculturation and cardiovascular risk factor control among populations with high proportions of immigrants has not been well studied.
  
  
  METHODS
  We studied 1,492 Hispanic participants in the Multi-Ethnic Study of Atherosclerosis (MESA) with hypertension, hypercholesterolemia, and/or diabetes. We used linear regression to examine the cross-sectional relationships between acculturation measures and cardiovascular risk factor levels. Outcome measures included systolic blood pressure (mm Hg), fasting low-density lipoprotein (LDL) cholesterol (mg/dL), and fasting blood glucose (mg/dL). Covariates included education, income, health insurance, physical activity, dietary factors, risk factor-specific medication use, duration of medication use, smoking, and body mass index.
  
  
  RESULTS
  There were 580 Hispanics with hypertension, 539 with hypercholesterolemia, and 248 with diabetes. After adjustment for age and gender, Spanish-speaking Hispanics with cardiovascular risk factors had higher systolic blood pressure, fasting LDL cholesterol, and fasting blood glucose compared to English-speaking Hispanics. Differences in systolic blood pressure were accounted for mainly by education, whereas differences in LDL cholesterol were almost entirely accounted for by cholesterol-lowering medication use. Differences in fasting glucose were partly accounted for by socioeconomic variables but were augmented after adjustment for dietary factors. Similar associations were observed between proportion of life in the United States and risk factor levels.
  
  
  CONCLUSIONS
  Among those with cardiovascular risk factors, Hispanics who spoke Spanish at home and lived less time in the United States had worse control of cardiovascular risk factors. Treatment strategies that focus on Hispanics with low levels of acculturation may improve cardiovascular risk factor control.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. peamrano@bidmc.harvard.edu
authors.forename: Pracha P
authors.initials: PP
authors.lastname: Eamranond
authors.forename: Anna T R
authors.initials: AT
authors.lastname: Legedza
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez-Roux
authors.forename: Namratha R
authors.initials: NR
authors.lastname: Kandula
authors.forename: Walter
authors.initials: W
authors.lastname: Palmas
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
mesh_terms: D000069:Acculturation; D003144:Communication Barriers; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology*; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology*; D007802:Language; D008297:Male; D008875:Middle Aged; D012307:Risk Factors