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Heart Disease Risk Is Rising Fastest Among U.S.-Born Hispanic Adults, Not Immigrants
In A Nutshell
- Heart disease became the leading cause of death for Hispanic adults in the U.S. in 2022, overtaking the long-assumed “Hispanic paradox” of better heart outcomes despite economic disadvantage.
- Hispanic adults born in the U.S. show higher rates of heart disease, stroke, and related risk factors than those who immigrated, with risk climbing the longer someone has lived in the country.
- Diabetes, stroke, and heart failure all show up years earlier in Hispanic adults than in white adults, and risk varies widely by heritage group, from Mexican to Puerto Rican to Cuban to Dominican.
- Uninsurance, poverty, low health literacy, language barriers, and a shortage of Hispanic cardiologists add to the risk beyond individual habits or genetics.
Heart disease became the leading cause of death for Hispanic adults in the United States in 2022, overtaking cancer and every other cause, according to a major new statement from the American Heart Association, published in the journal Circulation. For decades, researchers described a “Hispanic paradox”: despite more poverty, less insurance, and higher rates of obesity and diabetes, Hispanic adults somehow lived longer and died less often from heart disease than white adults. That protective edge appears to be disappearing.
One clear pattern involves where people were born: Hispanic adults born in the United States show higher rates of heart disease, stroke, and related risk factors than those who moved here, with risk rising the longer someone has lived in the country.
That pattern adds to evidence that adapting to life in the United States does not necessarily translate into better heart health, a warning sign for a population now nearly one in five Americans.
Lumping All Hispanic Adults Together Masks the Real Story
This wasn’t a single new experiment. It’s a scientific statement: a group of cardiologists and public health experts gathered by the American Heart Association reviewed a large body of existing research, most notably the Hispanic Community Health Study/Study of Latinos. A central point the authors make early on is that “Hispanic” is not one group. It covers people with roots in Mexico, Puerto Rico, Cuba, the Dominican Republic, Central America, and South America, each with different genetic backgrounds, cultures, and economic situations. Lumping all of that together, the statement argues, has hidden real differences and produced an oversimplified story about Hispanic health in America.
Diabetes, Blood Pressure, and Heart Failure Strike Hispanic Adults Earlier
Conditions that set the stage for heart attacks and strokes tend to show up earlier for Hispanic adults than for white adults. One number stands out: Mexican American adults were diagnosed with diabetes at an average age of 44.9, compared with 51.8 for non-Hispanic white adults, a gap of nearly seven years. Diabetes overall affects an estimated 15.5% of Hispanic adults, nearly double the rate among non-Hispanic white adults, and it often goes undiagnosed. Obesity affects an estimated 46% of Hispanic adults, highest among people of Puerto Rican and Dominican background.
High blood pressure tells the same story of hidden struggle. Roughly half of Hispanic men and over a third of Hispanic women have it; awareness, treatment, and control all lag behind non-Hispanic white adults.
Stroke shows the same troubling trend. Hispanic adults tend to have their first stroke around age 67, compared with 73 to 75 among non-Hispanic white adults. Heart failure shows up eight to nine years earlier as well, tied to high rates of obesity, diabetes, and high blood pressure.
Heart Disease Risk Varies Widely Across Hispanic Communities
Puerto Rican, Cuban, and Dominican adults tend to have the highest rates of high blood pressure. Cuban-background individuals tend to have higher cholesterol, Dominican-background individuals higher triglycerides, a fat in the blood linked to heart disease. Among women, 71% had at least one heart disease risk factor, with the heaviest burden among Puerto Rican women and the lightest among South American women.
Perhaps the most surprising finding involves acculturation, or how much someone has adopted American habits and lifestyle. Greater acculturation, measured by things like being born in the U.S. or holding U.S. citizenship, is linked to worse habits such as smoking and poor diet, along with higher rates of high blood pressure, diabetes, and obesity.
But the picture gets more complicated from there. Among people with more exposure to American culture, those with lower income and education had the highest predicted chance of developing high blood pressure, while those with higher education actually had lower risk of both diabetes and high blood pressure. Education, income, and other circumstances, not acculturation alone, appear to shape whether adapting to American life helps or hurts heart health.
The Hidden Barriers Behind Rising Hispanic Heart Disease Rates
Heart disease risk in Hispanic communities isn’t only about individual habits or genetics. About 20% of Hispanic adults remained uninsured in 2023, compared with 6.4% of white adults. Roughly 17% live below the federal poverty line, compared with 8.2% of non-Hispanic white adults. Around 41% have low health literacy, compared with 9% of non-Hispanic white adults, making it harder to understand medical instructions.
Hispanic adults are the largest group of non-native English speakers in the country, and inconsistent access to trained interpreters can hurt care quality. Only 5.8% of U.S. cardiologists identify as Hispanic, a gap the statement says limits trust between patients and doctors. Food insecurity adds another layer of strain, affecting about 16% of Hispanic households compared with 7% of non-Hispanic white households.
Any assumption that Hispanic adults carry a built-in protection against heart disease was always incomplete, and it’s becoming less true by the year. Disease is showing up younger, and the process of becoming more American, when it isn’t paired with more education and income, appears linked to a weakening of whatever advantage once existed. Fixing that will take better data by heritage group, more Hispanic representation in medical research, and healthcare systems built around the fact that “Hispanic” describes millions of people living very different lives.
Disclaimer: This article is based on findings from a peer-reviewed scientific statement and is intended for general informational purposes only. It is not a substitute for professional medical advice. Anyone concerned about their personal heart disease risk should speak with a doctor or other qualified healthcare provider.
Paper Notes
Limitations
The statement itself is a review and summary of existing research rather than a new original study, meaning its conclusions depend on the quality and consistency of the many studies it draws from. The authors note that Hispanic populations remain underrepresented in observational research and clinical trials, which limits how well findings can be generalized. Much of the genetic and genomic research referenced in the statement, including polygenic risk scores, has historically been developed using people of European ancestry, and the authors caution that these tools may not perform well or apply accurately to Hispanic populations without further study. The statement also points out that cardiovascular health data on Hispanic adults is often reported in aggregate rather than broken down by specific heritage group, which the authors say obscures meaningful differences and represents an ongoing gap in the research.
Funding and Disclosures
The document is a scientific statement from the American Heart Association, approved by the organization’s Science Advisory and Coordinating Committee and Executive Committee. All members of the writing group completed disclosure questionnaires identifying relationships that could represent conflicts of interest. Most writing group members reported no relevant relationships. A few reported research support or grant involvement, including one member noted as an investigator on NIH grants related to metabolic and cardiovascular disease in vulnerable groups, and another with research support tied to a study ancillary project and NIH funding. The American Heart Association states it works to avoid actual or potential conflicts of interest among writing panel members.
Publication Details
The paper is titled “State of Cardiovascular Disease and Stroke in Hispanic/Latino Adults in the United States: A Scientific Statement From the American Heart Association,” published in the journal Circulation. The writing group was chaired by Johanna Contreras, MD, MSc, FAHA, with David Aguilar, MD, MSc, FAHA, serving as vice chair, alongside writing group members Katia Bravo-Jaimes, MD; Yamnia Cortes, PhD, MPH, FAHA; Salvador Cruz-Flores, MD, FAHA; Jorge R. Kizer, MD, MSc, FAHA; Ileana Piña, MD, MPH, FAHA; Harrison Bonilla, DO; Carlos J. Rodriguez, MD, MPH, FAHA; Fatima Rodriguez, MD, FAHA; and Gladys Velarde, MD, FAHA. The statement was produced on behalf of several American Heart Association councils, including the Council on Epidemiology and Prevention, Council on Basic Cardiovascular Sciences, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Council on Lifestyle and Cardiometabolic Health, Council on Peripheral Vascular Disease, and the Stroke Council. The DOI is 10.1161/CIR.0000000000001463.
