title: Coronary death and myocardial infarction among Hispanics in the Northern Manhattan Study: exploring the Hispanic paradox.
abstract: OBJECTIVE
  Prior studies have reported that Hispanics have lower cardiovascular disease (CVD) mortality despite a higher burden of risk factors. We examined whether Hispanic ethnicity was associated with a lower risk of nonfatal myocardial infarction (MI) coronary death (CD) and vascular death.
  
  
  METHODS
  A total of 2671 participants in the Northern Manhattan Study without clinical CVD were prospectively evaluated. Cox models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of race-ethnicity with nonfatal MI, CD, and vascular death after adjusting for demographic and CVD risk factors.
  
  
  RESULTS
  Mean age was 68.8 (10.4) years; 52.8% were Hispanic (88% Caribbean-Hispanic). Hispanics were more likely to have hypertension (73.1% vs. 62.2%, p < .001) and diabetes (22.0% vs. 13.3%, p < .001), and less likely to perform any physical activity (50.1% vs. 69.2%, p < .001) compared to non-Hispanic whites (NHW). During a mean 10 years of follow-up there were 154 nonfatal MIs, 186 CD, and 386 vascular deaths. In fully adjusted models, Hispanics had a lower risk of CD (adjusted HR = 0.36, 95% CI: 0.21-0.60), and vascular death (adjusted HR = 0.62, 95% CI: 0.43-0.89), but not nonfatal MI (adjusted HR = 0.95, 95% CI: 0.56-1.60) when compared to NHW.
  
  
  CONCLUSIONS
  We found a "Hispanic paradox" for coronary and vascular deaths, but not nonfatal MI.
authors.affiliation: Department of Neurology, Columbia University, New York, NY, USA. jzw2@columbia.edu
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Willey
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Rodriguez
authors.forename: Yeseon Park
authors.initials: YP
authors.lastname: Moon
authors.forename: Myunghee C
authors.initials: MC
authors.lastname: Paik
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology* / Q000401:mortality*; D009519:New York City / Q000453:epidemiology; D012306:Risk; D014652:Vascular Diseases / Q000208:ethnology / Q000401:mortality; D044465:White People / Q000706:statistics & numerical data