Hispanics

The Hispanic population in the United States is a heterogeneous group with national origins or ancestry that may be Puerto Rican, Cuban, Mexican/Mexicano, Mexican American, Chicano, other Latin American, or other Spanish. Hispanics are the second largest minority group in the continental United States, comprising 22.4 million people, and increasing at a rate five times that of the rest of the United States. It has been estimated that by the early 21st century, Hispanics will become the largest minority group in the United States. CHD and cardiovascular disease mortality are approximately 20 percent lower among adult Hispanics than among whites in the United States. This is true despite a less favorable cardiovascular risk profile among Hispanics, who on average have a greater prevalence of diabetes, more obesity, a tendency towards central obesity, and lower HDL-cholesterol and higher triglyceride levels. Hispanics on average have higher CHD risk scores than non-Hispanic whites, but the Framingham algorithm has not been validated in this group. A comparison with Puerto Rican Hispanics indicates that Framingham scoring overestimates actual risk. Some have referred to this as the Hispanic paradox. However, even though Hispanics appear to have lower than expected mortality from CHD and CVD, the proportion of total deaths due to these two diseases is similar to that for whites in the United States and one cannot conclude that Hispanics are protected from CHD or that they should be treated less aggressively than other groups. The reasons for these differences are unclear.

In summary, despite limited data suggesting some differences in baseline risk between Hispanic and white populations, the ATP III panel concludes that the evidence for differences is not strong enough to justify separate guidelines for Hispanic populations. For this reason, no separate algorithm for lipid management is recommended and the same guidelines and risk stratification groupings are appropriate for Hispanics as for other populations.