AJPH
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow purchase articles
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Right arrow Get other permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (1)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Patel, K. V.
Right arrow Articles by Markides, K. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Patel, K. V.
Right arrow Articles by Markides, K. S.
Related Collections
Right arrow Aging
Right arrow Hispanics/Latinos
Right arrow Cardiovascular Disease
March 2003, Vol 93, No. 3 | American Journal of Public Health 433-435
© 2003 American Public Health Association

RESEARCH AND PRACTICE

Prevalence of and Risk Factors for Exertional Chest Pain in Older Mexican Americans

Kushang V. Patel, MPH, Sandra A. Black, PhD and Kyriakos S. Markides, PhD

Kushang V. Patel and Kyriakos S. Markides are with the Department of Preventive Medicine and Community Health and the Sealy Center on Aging, University of Texas Medical Branch, Galveston. Sandra A. Black is with the Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore.

Correspondence: Requests for reprints should be sent to Kyriakos S. Markides, PhD, Department of Preventive Medicine and Community Health, 301 University Blvd, Galveston, TX 77555-1153 (e-mail: kmarkide{at}utmb.edu).


   INTRODUCTION
TOP
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
Although numerous investigators have examined the physical manifestation of coronary heart disease (CHD) and its prognostic implications, most of these studies were conducted in samples of middle-aged men and used the Rose Questionnaire on Angina.1–6 Few, however, have examined the manifestation of CHD in the Mexican American population, and none has provided stable estimates of Rose angina in elderly Mexican Americans.7,8 In this brief, we examine the prevalence of and risk factors for exertional chest pain in Mexican Americans aged 65 and older with data from the Hispanic Established Population for the Epidemiological Study of the Elderly.


   METHODS
TOP
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
Sample
The Hispanic Established Population for the Epidemiological Study of the Elderly is an ongoing study of an area probability sample of 3050 community-dwelling Mexican Americans aged 65 years or older residing in Arizona, California, Colorado, New Mexico, and Texas. Baseline data collection took place during 1993 to 1994, with a response rate of 83%. Details of the Hispanic Established Population for the Epidemiological Study of the Elderly survey methods have been published elsewhere.9 Analyses in the current study included 2428 participants who completed the chest pain questionnaire items (333 subjects with a history of heart attack and 289 subjects too ill or cognitively impaired to answer chest pain questions were excluded).

Measures
Items from the Rose Questionnaire on Angina were used to classify exertional chest pain. Specifically, exertional chest pain was defined as ever having had pain or discomfort or pressure or heaviness in the chest on physical exertion.10,11 Medical conditions and other risk factors were assessed through self-report questions and anthropometric and clinical measurements. The Center for Epidemiological Studies Depression Scale was used to assess depressive symptoms.12–14 A value of 16 or greater was used to classify respondents with high levels of depressive symptoms. Six yes-or-no questions that measured stressful life events within the past year were summed into an index of stressors, with higher scores indicating greater amounts of stress.

Analyses
Prevalence estimates of exertional chest pain were calculated for each sex and age stratum (65–69 years, 70–79 years, and >= 80 years). Age-adjusted estimates of exertional chest pain prevalence were calculated by using the direct method with the 1990 US population as the standard. Mantel–Haenszel odds ratios were used to assess the relation between sex and exertional chest pain after adjusting for age. Multivariate logistic regression was then used to determine risk factors for exertional chest pain. All analyses were performed with SAS and SUDAAN statistical packages.15,16


   RESULTS
TOP
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
The age-adjusted prevalence of exertional chest pain was 7.1% for men and 12.8% for women (Table 1Go). Mantel–Haenszel odds ratios showed that women were 89% more likely to report exertional chest pain than were men after adjusting for age (Mantel–Haenszel odds ratio = 1.89; 95% confidence interval = 1.42, 2.52).


View this table:
[in this window]
[in a new window]
  		TABLE 1—— Estimated Prevalence of Exertional Chest Pain in Older Mexican Americans: Southwestern United States, 1993–1994
 
Table 2Go shows that women had a significantly higher likelihood of exertional chest pain than did men, even when adjusting for other factors. High levels of depressive symptoms (Center for Epidemiological Studies Depression Scale score >=16) were associated with more than a 2-fold increased likelihood of exertional chest pain. The likelihood of exertional chest pain increased 1.3 times for each reported life stressor. Diabetes and hypertension also were associated with an increased likelihood of exertional chest pain. Finally, low-income respondents, uninsured respondents, and former smokers (compared with never smokers) were significantly more likely to report exertional chest pain.


View this table:
[in this window]
[in a new window]
  		TABLE 2—— Logistic Regression Model of Exertional Chest Pain (n = 2172) in Older Mexican Americans: Southwestern United States, 1993–1994
 

   DISCUSSION
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
Data from the Hispanic Established Population for the Epidemiological Study of the Elderly show that the age-adjusted prevalence of exertional chest pain for older Mexican American women is significantly higher than that for Mexican American men. This large sex difference is surprising given the higher heart disease mortality rates of Hispanic men.17 This counterintuitive pattern may be partially explained by the higher prevalence of vasospastic and microvascular angina in women, which does not necessarily lead to myocardial infarction.18–20 In addition, our prevalence estimates for both men and women were higher than those reported for older non-Hispanic Whites from other Established Populations for the Epidemiological Study of the Elderly samples.10 Data from the San Antonio Heart Study also showed a higher prevalence among middle-aged Mexican Americans than among middle-aged non-Hispanic Whites.7 This pattern is also surprising considering that CHD mortality rates for non-Hispanic men and women have consistently been higher than those for Hispanic people.17 This finding is consistent with the Hispanic paradox21,22 whereby Mexican Americans report higher prevalence of risk factors for heart disease than do nonHispanic Whites but maintain a heart disease mortality advantage.

Study limitations include absence of data on important risk factors for CHD (e.g., cholesterol) and possible concomitant respiratory disease that might be associated with exertional chest pain. Nevertheless, high prevalence of exertional chest pain may be partly due to high prevalence of depressive symptomatology in our sample.23,24 Previous research has shown that Mexican Americans tend to somatize their emotional problems.25 Because pathophysiological evidence shows that depression and stress could exacerbate a coronary condition,26–28 our findings should encourage clinicians to address these health issues with older Mexican American patients.


   Acknowledgments
 
Support was provided by grants from the National Institute on Aging (R01 AG10939 and T32 AG00 270-02). Fieldwork was completed by Harris Interactive, Inc.

Human Participant Protection

The Hispanic Established Population for the Epidemiological Study of the Elderly was approved by the institutional review board of the University of Texas Medical Branch.


   Footnotes
 
K. V. Patel, S. A. Black, and K. S. Markides equally contributed to the study design and writing of this brief. K. V. Patel performed the data analysis with consultation from S. A. Black and K. S. Markides.

Peer Reviewed

Accepted for publication June 7, 2002.


   References
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Rose GA. The diagnosis of ischaemic heart pain and intermittent claudication in field studies. Bull World Health Organ. 1962;27:645–658.[Web of Science][Medline]

2. Rose G, Hamilton PS, Keen H, Reid DD, McCartney P, Jarrett RJ. Myocardial ischaemia, risk factors and death from coronary heart-disease. Lancet. 1977;1:105–109.[Web of Science][Medline]

3. Blackwelder WC, Kagan A, Gordon T, Rhoads GG. Comparison of methods for diagnosing angina pectoris: the Honolulu Heart Study. Int J Epidemiol. 1981;10:211–215.[Abstract/Free Full Text]

4. Feinleib M, Lambert PM, Zeiner-Henriksen T, Rogot E, Hunt BM, Ingster-Moore L. The BritishNorwegian Migrant Study—analysis of parameters of mortality differentials associated with angina. Biometrics. 1982;38(suppl):55–74.

5. Reunanen A, Aromaa A, Pyorala K, Punsar S, Maatela J, Knekt P. The Social Insurance Institution’s coronary heart disease study: baseline data and 5-year mortality experience. Acta Med Scand. 1983;673(Suppl):1–120.

6. Hagman M, Wilhelmsen L, Pennert K, Wedel H. Factors of importance for prognosis in men with angina pectoris derived from a random population sample: the Multifactor Primary Prevention Trial, Gothenburg, Sweden. Am J Cardiol. 1988;61:530–535.[Web of Science][Medline]

7. Mitchell BD, Hazuda HP, Haffner SM, Patterson JK, Stern MP. High prevalence of angina pectoris in Mexican-American men: a population with reduced risk of myocardial infarction. Ann Epidemiol. 1991;1:415–426.[Medline]

8. LaCroix AZ, Haynes SG, Savage DD, Havlik RJ. Rose Questionnaire angina among United States black, white, and Mexican-American women and men: prevalence and correlates from The Second National and Hispanic Health and Nutrition Examination Surveys. Am J Epidemiol. 1989;129:669–686.[Abstract/Free Full Text]

9. Markides KS, Stroup-Benham CA, Goodwin JS, Perkowski LC, Lichtenstein M, Ray LA. The effect of medical conditions on the functional limitations of Mexican-American elderly. Ann Epidemiol. 1996;6:386–391.[Web of Science][Medline]

10. LaCroix AZ, Guralnik JM, Curb JD, Wallace RB, Ostfeld AM, Hennekens CH. Chest pain and coronary heart disease mortality among older men and women in three communities. Circulation. 1990;81:437–446.[Abstract/Free Full Text]

11. Seeman T, Mendes de Leon CF, Berkman L, Ostfeld A. Risk factors for coronary heart disease among older men and women: a prospective study of community-dwelling elderly. Am J Epidemiol. 1993;138:1037–1049.[Abstract/Free Full Text]

12. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

13. Blazer D, Hughes DC, George LK. The epidemiology of depression in an elderly community population. Gerontologist. 1987;27:281–287.[Web of Science][Medline]

14. Himmelfarb S, Murrell SA. Reliability and validity of five mental health scales in older persons. J Gerontol. 1983;38:333–339.

15. SAS Procedures Guide, Version 8.1. Cary, NC: SAS Institute Inc; 2000.

16. Shah BV, Barnwell BG, Bieler GS. SUDAAN User’s Manual, Release 7.5.6. Research Triangle Park, NC: Research Triangle Institute; 2000.

17. Murphy SL. Deaths: final data for 1998. Natl Vital Stat Rep. 2000;48:1–105.[Medline]

18. Douglas PS, Ginsburg GS. The evaluation of chest pain in women. N Engl J Med. 1996;334:1311–1315.[Free Full Text]

19. Sullivan AK, Holdright DR, Wright CA, Sparrow JL, Cunningham D, Fox KM. Chest pain in women: clinical, investigative, and prognostic features. BMJ. 1994;308:883–886.[Abstract/Free Full Text]

20. Cannon RO III, Camici PG, Epstein SE. Pathophysiological dilemma of syndrome X. Circulation. 1992;85:883–892.[Free Full Text]

21. Markides KS, Coreil J. The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep. 1986;101:253–265.[Web of Science][Medline]

22. Francini L, Ribble JC, Keddie AM. Understanding the Hispanic paradox. Ethn Dis. 2001;11:496–518.[Medline]

23. Black SA, Goodwin JS, Markides KS. The association between chronic diseases and depressive symptomatology in older Mexican Americans. J Gerontol A Biol Sci Med Sci. 1998;53:M188–M194.[Abstract]

24. Black SA, Markides KS, Miller TQ. Correlates of depressive symptomatology among older community-dwelling Mexican Americans: the Hispanic EPESE. J Gerontol B Psychol Sci Soc Sci. 1998;53:S198–S208.[Abstract]

25. Angel R, Guarnaccia PJ. Mind, body, and culture: somatization among Hispanics. Soc Sci Med. 1989;28:1229–1238.

26. Markovitz JH, Matthews KA. Platelets and coronary heart disease: potential psychophysiologic mechanisms. Psychosom Med. 1991;53:643–668.[Abstract/Free Full Text]

27. Carney RM, Freedland KE, Rich MW. Depression as a risk factor for cardiac events in patients with coronary heart disease: a review of possible mechanisms. Ann Behav Med. 1995;17:142–149.[Web of Science][Medline]

28. Gullette EC, Blumenthal JA, Babyak M, et al. Effects of mental stress on myocardial ischemia during daily life. JAMA. 1997;277:1521–1526.[Abstract/Free Full Text]





This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow purchase articles
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Right arrow Get other permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (1)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Patel, K. V.
Right arrow Articles by Markides, K. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Patel, K. V.
Right arrow Articles by Markides, K. S.
Related Collections
Right arrow Aging
Right arrow Hispanics/Latinos
Right arrow Cardiovascular Disease

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2003 by the American Public Health Association