{'fraction_non_alphanumeric': 0.02213393870601589, 'fraction_numerical': 0.005959137343927355, 'mean_word_length': 5.25, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Acculturation and evolving cardiovascular disease: An unhealthy dyad

Acculturation has been defined as the ‘adoption of or adaptation to a different culture’; and for immigrants, this may result in the adoption of cardiovascular disease (CVD) risk factors. In terms of health indicators, immigrant populations vary considerably from every country and indeed even within an individual country. This editorial will be restricted to the Chinese immigrant population to various western countries. A Canadian study in 1999 showed that immigrant Chinese Canadians were less likely to die of CVD compared with immigrant South East Asian and Caucasian Canadians. The 2016 European Guidelines on CVD prevention in clinical practice utilise different modifiers for their risk factor SCORE paradigm with South East Asians being at 1.4, whereas Eastern Asians have a modifier of 0.7. This may lead healthcare practitioners to conclude falsely that the Chinese immigrant population may be less susceptible to the maladaptive lifestyle habits of western countries. In a previous issue of the European Journal of Preventive Cardiology, Jin et al. present the results of a prospective population-based cohort study of Chinese immigrants to Australia. This was a subset of the 45and-Up Study, which is a large cohort study of New South Wales residents aged 45 years and older. The mean age of the Chinese immigrants was 59 years and the majority had been in Australia for at least 10 years. Three acculturation variables were used for analysis and included: (a) age at migration; (b) length of time since migration; and (c) other language(s) spoken at home. The cardiovascular endpoints were self-reported in the English language and included coronary heart disease (CHD) and stroke; however, some indicators, such as peripheral vascular disease, were not collected. The risk factors of hypertension, diabetes, dyslipidaemia, current smoking, overweight/obesity and physical inactivity were analysed. Important covariates of age, sex, educational attainment, marital status and proxies of socioeconomic status were analysed, but did not affect the results. None of the acculturation variables influenced the hard CVD endpoints. With greater exposure to acculturation, there was an increase in the incidence of diabetes and the presence of more than three risk factors. Because the study included only individuals with English language proficiency, the acculturation measures may not reflect the true prevalence of CVD risk factors in this population. Non-English-speaking immigrants may be less likely to be screened for CVD risk factors, due to lack of access and awareness. Furthermore, the results of the study may be an overestimation if non-Englishspeaking Chinese immigrants maintained their customary diet and perhaps had fewer CVD risk factors. A recent study by the same authors provides further details with respect to the risk factors for Chinese immigrants to Australia. These studies are both limited by their cross-sectional designs; hopefully future studies can analyse these factors on a longitudinal basis. So, what are some of the key findings? The findings are depicted in Figure 1, which represents a causal web illustrating the various factors influencing disease states and the interactions among them. Distal and proximal factors operate through both intermediate factors and directly on disease states. Some of the key CVD health determinants for immigrant Chinese to Australia and other countries are depicted here.