Objectives: Studies primarily using prevalence data suggest the relationship between body mass index (BMI) and risk factors for cardiovascular disease may vary by ethnicity. The objective of this study was to examine longitudinally the associations of BMI and ethnicity with transitions from a baseline state without evidence of chronic disease to the onset of hypertension, hyperlipidemia, or both.
Design: The study population comprised members of a large insurer in Hawaii. Individuals were eligible if continuously enrolled for at least one year without evidence of major chronic disease. Analyses used multi-state models to measure the relative rates of transitions from the baseline state to developing hypertension, hyperlipidemia, or both. All analyses were adjusted for age, sex, education, number of office visits, and island of residence.
Results: Native Hawaiians had the highest prevalence of overweight and obesity followed by Caucasians, Filipinos, Japanese, Chinese, and Koreans. Relative rates of transitions by ethnicity, however, did not parallel the prevalence of overweight and obesity. Japanese and Filipino ethnicities had significantly faster transition rates than Whites for all four study transitions, rates that ranged from 20% to more than two-fold faster. Chinese and Koreans also had significantly higher rates of many transitions compared to Whites. Native Hawaiians, by contrast, had a slower transition rate than Whites to developing hyperlipidemia without hypertension, and relatively faster transitions to the other outcome states.
Conclusions: The study offers longitudinal evidence of different patterns of risk for developing hypertension and hyperlipidemia among Asians, Whites, and Native Hawaiians.