Abstract
Introduction: Perceived discrimination stress and acculturation are associated with CVD, but their association with cardiac structure and function have not been well studied. Hypothesis: We hypothesized that increased discrimination would be associated with abnormal LV structure and function and that low acculturation positively moderates this association after adjusting for CVD risk factors. Methods: ECHO-SOL enrolled Hispanics/Latinos, aged 45-74, living in the Bronx, Chicago, Miami, and San Diego. Echocardiographic measurements included: LV Mass Index (LVMI), LV geometry, left atrial volume index (LAVI), LV diastolic dysfunction (LVDD), and LVEF. Discrimination scales from the Brief PEDQ-CV included: total discrimination, exclusion/rejection, stigmatization/devaluation, discrimination at work/school, and threat/aggression. Spanish-language preference, foreign-born and shorter length of U.S. residence defined low acculturation. Linear regression, using sampling weights, assessed the association of outcomes with discrimination measures, adjusting for CVD risk factors, followed by stratification by acculturation level. Results: Participants (n=1818) were largely Spanish-speaking (86%), foreign-born (92%), with 49% living in the U.S. >20 years. Mean age was 56.4 years (SE = 0.37). Fifty percent had hypertension, 28% had diabetes, and 44% were obese. Mean total discrimination was 24.8 (SE = 0.4). LVDD was 52% and abnormal LV geometry was 45%. In unadjusted analysis, stigmatization/devaluation was associated with higher LVMI (β = 0.88; p = 0.003) and LAVI (β = 0.26; p = 0.003). Discrimination at work/school was associated with higher LVEF (β = 0.197; p = 0.007). In adjusted analysis, stigmatization/devaluation continued to predict higher LAVI (β = 0.30; p = 0.0009) but not LVMI. Discrimination at work/school continued to predict increasing LVEF (β = 0.22; p = 0.001). Total discrimination became significant for increased LVEF (β = 0.06; p = 0.006). In adjusted analyses stratified by acculturation, stigmatization/devaluation predicted higher LAVI among Spanish language preference (β = 0.30; p = 0.004) and foreign-born individuals (β = 0.32; p = 0.0016). Work/school discrimination (β = 0.20; p = 0.006) predicted increasing LVEF in foreign-born individuals. Total discrimination predicted increased LVEF among Spanish language preference (β = 0.073; p = 0.008) and foreign-born individuals (β = 0.07; p = 0.007). Stigma/devaluation was associated with higher LVMI among Spanish language preference (β = 0.97; p = 0.004) and foreign-born individuals (β = 1.09; p = 0.0005) in unadjusted but not adjusted models. Conclusions: In conclusion, stigma/devaluation predicted higher LVMI and LAVI in unadjusted analyses but only higher LAVI when adjusted. Total and work/school discrimination predicted higher LVEF. Low acculturation stratification resulted in similar findings.