Acculturation is Associated with Cardiovascular Disease Risk in West African Immigrants in the United States

Purpose: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in the United States (US), accounting for more than 40% of all deaths, with ethnic minorities bearing a disproportionate burden of disease. The causes of increased risk for CVD in African-descent populations in the diaspora are incompletely understood. They may involve socio-economic and environmental factors, lifestyle changes, and cultural changes. These cultural changes (acculturation) that occur after migration of immigrants to the US may be detrimental or beneficial to health. The purpose of the Afro-Cardiac study was to examine the relationship between acculturation and CVD risk in West African immigrants in the US, who have increased 40-fold between 1990-2010.

Methods: A cross-sectional study of West African immigrants (Ghanaians and Nigerians) between the ages of 35-74 years was conducted in the Baltimore-Washington, DC metropolitan area. CVD risk factors (total cholesterol, HDL-cholesterol, hypertension, overweight/obesity, diabetes, physical inactivity and smoking) were determined according to the American Heart Association guidelines (AHA) guidelines. Participants with Pooled Cohort Equations (PCE) scores ≥7.5% and ≥3 CVD risk factors were deemed high risk for CVD in multivariable logistic analyses. Acculturation was assessed with length of residence (proxy) and the modified Psychological Acculturation Scale. Per this scale, individuals were classified as 1) Traditionalist, identified more with their ethnic culture than host culture; 2) Integrationist, developed a bicultural orientation and successfully integrated both cultures; 3) Assimilationist, identified more with the host culture than their ethnic culture; or 4) Marginalist, identified with neither the host nor ethnic cultures.

Results: Participants (n=253) had a mean age of 49.5±9.2 years and 58% were female. The mean length of US residence was 13.6±8.8 years. The prevalence of CVD risk factors was high with the exception of hyperlipidemia and smoking. The majority (54%) had ≥3 CVD risk factors and 28% had PCE scores ≥7.5%. About half (53%) of those who had hypertension were on antihypertensive treatment with females more likely to report taking their antihypertensive medication than their male counterparts (64% vs. 36%; p=0.003). Although females were significantly more likely to be treated for hypertension, males (71%) were more likely to have their BP controlled than females (42%) [p=0.045].  In males, residing in the US for ≥10 years was significantly associated with a 5-fold (95%CI: 1.28-20.33) odds of overweight/obesity and an 8-fold (95%CI: 2.09-30.80) odds of having high CVD risk (PCE scores ≥7.5%). Females who had resided in the US for ≥10 years had a 3-fold (95%CI: 1.04-6.551) odds of being diagnosed with hypertension than newer residents. Acculturation strategies identified by participants were as follows: Integrationists, 166(66%); Traditionalists, 80(32%); Marginalists, 5(1%); or Assimilationists, 2(1%). Integrationists had a 0.46(95% CI: 0.24-0.87) lower odds of having ≥3 CVD risk factors and 0.38(95% CI: 0.18-0.78) lower odds of having PCE score ≥7.5% than Traditionalists.

Conclusion: Although increasing years of US residence was associated with higher CVD risk, we observed that Integrationists who equally identified with American and West-African cultures had lower risk for CVD and were more likely to have controlled blood pressures than Traditionalists who identified more with the West-African culture. Hence, ensuring the successful integration of West African immigrants may reduce the risk of CVD in new African immigrants. These findings suggest that acculturation should be considered as a meaningful predictor of increased CVD risk and culturally-sensitive tailoring of CVD risk reduction strategies may be needed in West African immigrants.