Photo portrait of a multi-generational Asian American family relaxing in park together. Source: Shutterstock

New NHLBI study focuses on Asian Americans, Native Hawaiians, and Pacific Islanders

Aims to understand cardiovascular disease to improve prevention in understudied populations

For decades, the NHLBI has studied cardiovascular health and disease in different racial and ethnic populations, and those studies have yielded valuable insights into how to prevent and reduce health disparities among White, Black, Hispanic, and Native American people.

Yet, there’s little data about the cardiovascular health of the 26.5 million people in the United States who identify as Asian American, Native Hawaiian or Pacific Islander (NHPI). Collectively, these groups make up about 8% of the U.S. population and represent about 40 ethnic subgroups. And Asian Americans are the fastest growing minority group in the nation, according to U.S. Census reports.

In response, NHLBI has launched an epidemiological cohort that focuses on these populations. It is called MOSAAIC, which stands for Multi-ethnic Observational Study in American Asian and Pacific Islander Communities.

“It’s an exciting and historic development,” said Gina Wei, M.D., M.P.H., director of the Prevention and Population Sciences Program in NHLBI’s Division of Cardiovascular Sciences (DCVS) and a key force in launching the new cohort.

It’s also one that’s urgently needed, said Yuling Hong, M.D., Ph.D., chief of the Epidemiology Branch in DCVS and the scientific advisor for the study. “Research on these understudied groups can help eliminate disparities and advance health equity in ways never seen before,” he said.

Hong knows firsthand the value of research like this. He’s also the NHLBI’s project scientist for the iconic Framingham Heart Study, which along with the Jackson Heart Study, the Study of Latinos, the Strong Heart Study, and other NHLBI cohort studies have produced critical, sometimes life-saving findings specific to the cardiovascular health of White, Black, Hispanic, and Native American communities.

While Asian and NHPI populations have been included in other NHLBI studies, Hong acknowledges, these groups typically have represented only about 2% of study cohort participants. Additionally, said Wei, Asian and NHPI populations have often been incorrectly viewed as one uniform group.

“We’re not all the same,” she said. “Different Asian American and NHPI groups have different experiences and exposures to risk factors, which results in different disease burdens. This study recognizes that and moves the research forward.”

Launched in August 2023, the seven-year study will recruit about 10,000 adults, ages 18-64, from across the country. Notably, it will focus not only on cardiovascular health, but on other conditions like lung health, mental health, and social determinants of health in individuals who self-identify as having ancestral background from East Asia, South Asia, Southeast Asia; or self-identify as Native Hawaiian and/or Pacific Islander.

Researchers already have some knowledge of existing health disparities among these groups. For example, data show a higher prevalence of coronary heart disease in Indian, Vietnamese, and NHPI-origin individuals, and high levels of stroke among Chinese and Filipino populations compared to the White American populations. Studies have shown that different cardiovascular risk factors — smoking, diabetes, hypertension, abnormal cholesterol, and obesity — show up at different rates in different groups. The new study will sort out the data and shed more light on the health of these Asian American and NHPI populations.

Researchers will conduct surveys to capture as much knowledge from participants as they can: their demographic information, health history, lifestyle and behaviors, environment, and mental health. They will look for risk factors for heart disease, metabolic disorders, sleep, and other health problems. Participants will undergo physical examinations, the protocol for which is being developed, but likely to include anthropometry (body measurements), blood pressure, electrocardiogram measurements, and spirometry (lung measurements). They will also likely be asked to provide biospecimens such as blood, saliva, urine and stool to help shed light on diseases.

The study will take place at six research institutions — the Fred Hutchinson Cancer Center in Seattle, Washington, the study’s coordinating center; and five clinical/community field centers — the University of Hawaii at Mānoa, Stanford University, the University of Chicago, the Fox Chase Cancer Center in Philadelphia, and the New York University Langone Health/Perlmutter Cancer Center.

The study is primarily funded by NHLBI, with support from four other NIH institutes: the National Human Genome Research Institute (NHGRI), the National Institute of Mental Health (NIMH), the National Institute on Minority Health and Health Disparities (NIMHD), and the National Institute of Neurological Disorders and Stroke (NINDS).

Advocacy for the new cohort gained momentum during the COVID-19 pandemic, which saw a rise in racist sentiment directed at the Asian communities. Across the country, communities responded with a push for more recognition of the contributions of Asian American and NHPI populations and a pledge to be more inclusive.

Hong sees the study as a big step in that inclusion effort.

“Perhaps decades from now, researchers will look back on this moment as a pivotal time when research on these populations began to grow and help improve the lives of Asian Americans and NHPI groups, similar to when Framingham started 75 years ago,” Hong said. “We look forward to helping make that happen.”

EDITOR’S NOTE: May is Asian American, Native Hawaiian, and Pacific Islander Heritage Month.