title: Acculturation and cardiovascular risk factor control among Hispanic adults in the United States.
abstract: OBJECTIVE
  We sought to determine whether low acculturation, based on language measures, leads to disparities in cardiovascular risk factor control in U.S. Hispanic adults.
  
  
  METHODS
  We studied 4729 Hispanic adults aged 18 to 85 years from the National Health and Nutrition Examination Survey, 1999-2004. We examined the association between acculturation and control of low-density lipoprotein (LDL) cholesterol, blood pressure, and hemoglobin A1c based on national guidelines among participants with hypercholesterolemia, hypertension, and diabetes, respectively. We used weighted logistic regression adjusting for age, gender, and education. We then examined health insurance, having a usual source of care, body mass index, fat intake, and leisure-time physical activity as potential mediators.
  
  
  RESULTS
  Among participants with hypercholesterolemia, Hispanic adults with low acculturation were significantly more likely to have poorly controlled LDL cholesterol than Hispanic adults with high acculturation after multivariable adjustment (odds ratio [OR] = 3.4, 95% confidence interval [CI] 1.2, 9.5). Insurance status mildly attenuated the difference in LDL cholesterol control. After adjusting for diet and physical activity, the magnitude of the association increased. Other covariates had little influence on the observed relationship. Among those with diabetes and hypertension, we did not observe statistically significant associations between low acculturation and control of hemoglobin A1c (OR = 0.5, 95% CI 0.2, 1.2), and blood pressure (OR = 1.1, 95% CI 0.6, 1.7), respectively.
  
  
  CONCLUSIONS
  Low levels of acculturation may be associated with increased risk of inadequate LDL cholesterol control among Hispanic adults with hypercholesterolemia. Further studies should examine the mechanisms by which low acculturation might adversely impact lipid control among Hispanic adults in the U.S.
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline, MA, USA. peamranond@partners.org
authors.forename: Pracha P
authors.initials: PP
authors.lastname: Eamranond
authors.forename: Christina C
authors.initials: CC
authors.lastname: Wee
authors.forename: Anna T R
authors.initials: AT
authors.lastname: Legedza
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
authors.forename: Suzanne G
authors.initials: SG
authors.lastname: Leveille
mesh_terms: D000069:Acculturation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000208:ethnology* / Q000209:etiology; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000208:ethnology; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin