Irma B. Ancheta

Filipino American women (FAW) have high incidence of coronary heart disease and high low-density lipoprotein cholesterol (LDL-C). The distribution of rs11206510 proprotein-convertase subtilisin-kexin type 9 (PCSK9) and rs1122608 low-density lipoprotein receptor (LDLR) single nucleotide polymorphisms (SNPs), known for genetic influences on LDL-C, is unknown in this population. The objective of this study was to examine the genetic determinants of LDL-C, their association with LDL-C, and effects of statins on LDL-C given the genetic determinants in this high-risk population. Data were obtained from the FAW Cardiovascular Study (N = 338) of women ages 40 to 65 years from four major U.S. cities between 2011 and 2013. Roche Modular methodology and Luminex-oligonucleotide ligation assay procedure were used for allele frequency, genotype, LDL-C, and lipid analysis. Analysis of variance was used to determine differences between genotype groups. Genotype and statin effect on LDL-C were tested using the generalized linear model procedure of SAS. The distribution of rs11206510 PCSK9 genotypes was 88% TT, 11% TC, and 1% CC, and the rs1122608 LDLR genotype distribution was 83% GG, 17% GT, and 0% TT. These SNPs showed no association with mean LDL-C in this cohort. FAW on statin medications had lower LDL levels regardless of their PCSK9 or LDLR genotypes. Most FAW had a gain-of-function allele of PCSK9 and LDLR. This predominance in FAW cohort may account for the high percentage of subjects with elevated LDL-C. In a population at high risk for hypercholesterolemia, optimal treatment with statins should be considered where appropriate.

Although cardiovascular disease (CVD) is a leading cause of morbidity and mortality of Filipino–Americans, conventional CVD risk calculators may not be accurate for this population. CVD risk scores of a group of Filipino–American women (FAW) were measured using the major risk calculators. Secondly, the sensitivity of the various calculators to obesity was determined. This is a cross-sectional descriptive study that enrolled 40–65-year-old FAW (n = 236), during a community-based health screening study. Ten-year CVD risk was calculated using the Framingham Risk Score (FRS), Reynolds Risk Score (RRS), and Atherosclerotic Cardiovascular Disease (ASCVD) calculators. The 30-year risk FRS and the lifetime ASCVD calculators were also determined. Levels of predicted CVD risk varied as a function of the calculator. The 10-year ASCVD calculator classified 12 % of participants with ≥10 % risk, but the 10-year FRS and RRS calculators classified all participants with ≤10 % risk. The 30-year “Hard” Lipid and BMI FRS calculators classified 32 and 43 % of participants with high (≥20 %) risk, respectively, while 95 % of participants were classified with ≥20 % risk by the lifetime ASCVD calculator. The percent of participants with elevated CVD risk increased as a function of waist circumference for most risk score calculators. Differences in risk score as a function of the risk score calculator indicate the need for outcome studies in this population. Increased waist circumference was associated with increased CVD risk scores underscoring the need for obesity control as a primary prevention of CVD in FAW.

Although elevated body mass index (BMI) increases the risk for cardiovascular disease (CVD) and diabetes universally, the BMI associated with increased risk for these two diseases needs to be established for Filipino American women (FAW). The relationship of BMI with diabetes and other CVD risk factors in FAW was investigated to determine if BMI levels less than the conventional 25 kg/m2 are associated with increased CVD risk factors. In a cross-sectional study conducted in four cities, FAW (n=193), aged 40 to 65 years, were screened for CVD risk factors and diabetes. Mean concentrations and prevalence of CVD risk factors were examined as a function of BMI category (BMI < or =22.9 n=41, BMI 23-24.9 n=46, BMI 25-29.9 n=75, and BMI > or =30 n= 31). Body mass index correlated significantly with waist circumference (P<.0001), systolic blood pressure (P<.0001), diastolic blood pressure (P<.001), fasting blood glucose (P<.05), hemoglobin A1c (P<.001), triglycerides (P<.001), high sensitivity C-reactive protein (P<.001) and high density lipoprotein -C (P<.001). The prevalence of diabetes, decreased levels of high density lipoprotein-cholesterol, hypertension, elevated triglycerides, and high sensitivity C-reactive protein increased significantly (P<.01-.001) with BMI categories starting at BMI 23-24.9 kg/m2. Body mass index was an excellent predictor of elevated CVD risk factors in this population and the prevalence of most of these factors increased at BMIs as low as 23-24.9 kg/m2 suggesting a need to investigate risk factors and CVD events as a function of BMI in larger studies of Filipino American women.

Cardiovascular disease (CVD) is a significant cause of morbidity and mortality in women of Filipino ethnicity. The objective of our work was to determine if metabolic syndrome (MetS), a modifiable CVD risk factor, differs in women as a function of country of residency and to determine if, CVD prevention strategies need to differ for these groups of Filipino women. Data were collected in community-based health screenings for this cross-sectional study. PARTICIPANTS were recruited at places of worship in southeast United States (n=60) and Central Visayas, Philippines (n=56). Prevalence of MetS and its component factors as defined by the International Diabetes Federation criteria. The prevalence of MetS in Filipino women (FW) and Filipino American women (FAW) groups was similar (52% vs 55%, P=.08) although the prevalence of elevated waist circumference was greater for FAW (78% vs 59%, P=.03). Conversely, the percentage of FW women with risk-associated high-density lipoprotein (HDL) levels was higher than the FAW group (84% vs 42%, P<.001). Other MetS component factors (blood pressure, glucose and triglycerides) did not significantly differ between groups. Similar high rates of MetS were observed in Filipino women regardless of the country of residency although the FAW tended to have higher rates of central obesity while the FW tended to have higher rates of risk-associated HDL levels. Further research should examine the cause of these differences in order to develop better cardiovascular screening and intervention strategies.

Healthcare providers should be concerned with improving the quality of life (QOL) of patients with heart failure (HF) because disease-specific QOL is linked to disease progression. The present study investigated the significance of elevated b-type natriuretic peptide (BNP), NYHA classification and depression to HF-related QOL to develop better management strategies. Outpatient subjects with left ventricular systolic dysfunction (n=108; mean age=64.9+/-12) completed the self-administered Minnesota Living with Heart Failure questionnaire and the Center for Epidemiologic Studies Depression Scale. Functional status was measured using the New York Heart Association Classification (NYHA) and BNP concentrations were measured in plasma samples. Multiregression analysis determined that plasma BNP levels did not contribute significantly to the total QOL score while depression (r=0.63, t ratio=7.43, P<.0001) and NHYA class (r=0.47, t ratio=3.31, P<.001) were significant contributors. NYHA III subjects exhibited worse depression scores (II 15+/-7 and III: 22+/-10, P<.001) and elevated plasma BNP (II: 2.0+/-0.5 and III: 2.4+/-0.6, P<.001). Low-cost psychological assessments are recommended to evaluate depression and suggest that those HF patients with NYHA III be closely monitored for depression and reduced QOL.