Diabetes and cardiovascular disease. Is there a true Hispanic paradox?

INTRODUCTION: The observation that Hispanics have lower all-cause and cardiovascular mortality despite increased prevalence of diabetes and obesity, lower socioeconomic status and barriers to health care, has been termed the "Hispanic Paradox". There are problems of data reliability and confounding bias in the analysis of this paradox.

MATERIAL AND METHODS: An electronic search in the MEDLINE was performed for information published during the last 30 years: National cohort studies, population based and case-control studies, vital statistics and major review articles were included using the following key words: Cardiovascular disease and overall mortality by ethnicity, in diabetic patients from the US and Latin America.

RESULTS: A total of 140 articles were included, classified and analyzed separately according to the following thematic: The U.S. Hispanic population, cardiovascular (CV) and overall mortality rates in Hispanics, type 2 diabetes in Hispanics, diabetes and coronary heart disease, CV disease in Hispanic diabetic patients, CV risk profile in Hispanics, ethnicity and CV risk factors, diabetes and CV disease in Latin America and a search for the protective or causative factors for CV disease.

CONCLUSIONS: Much controversy and diverse confounding factors surround the Hispanic paradox. The present data suggest that the lower mortality in Hispanics is not "genuine", but is rather caused by migratory factors and probably mild distortions due to selection combined with mild reporting errors that may produce the appearance of a paradox when there is none at all. Even more, recent studies do not confirm the lower mortality rates in US Hispanics compared to the Non Hispanic White population, or that Hispanics from Latin America have lower mortality rates from CV disease than the US population. In the current era of globalization, major changes in the socio-economic and cultural status of people in developing countries and disadvantaged and minority groups in developed nations has lead to the current diabetic and atherosclerotic heart disease epidemic.