Increased Risk of Myocardial Infarction and Stroke Among Multiracial Asian and Pacific Islander Adults With Diabetes: Evidence From Electronic Health Records

BACKGROUND: Type 2 diabetes (henceforth diabetes) contributes to cardiovascular disease burden. Compared with Non-Hispanic White individuals, Asian American and Pacific Islander individuals have lower cardiovascular disease burden despite having higher diabetes burden. We examined differences in the association of diabetes with incident cardiovascular disease by disaggregated single-race and multiracial Asian American and Pacific Islander groups. METHODS: We used electronic health record data from the Cardiovascular Disease Among Asians and Pacific Islanders Study, a retrospective cohort of single-race and multiracial Asian American and Pacific Islander individuals in Northern California and Hawaii (N=303 958). Cox proportional hazard models examined the association between diabetes status at baseline and incident myocardial infarction (MI) and stroke by race. We calculated the incidence rate by diabetes status and race per 1000 person-years and stratified by age. RESULTS: People with diabetes had a nearly 4-fold greater MI incidence (3.7% versus 0.9%) and 3-fold greater stroke incidence (4.8% versus 1.8%) compared with those without diabetes, and regardless of race. Compared with Non-Hispanic White people with diabetes (MI: 5.5; stroke: 7.6), most single-race Asian groups with diabetes had lower age-adjusted incidence (per 1000 person-years) of MI and stroke. However, a greater incidence of cardiovascular disease was seen among multiracial Pacific Islander and Asian (MI: 14.6; stroke: 11.1); Pacific Islander, Asian, and White (MI: 16.6; stroke: 12.1); and Pacific Islander and White (MI: 13.0; stroke: 12.1) groups with diabetes. CONCLUSION: Multiracial Asian American and Pacific Islander people with diabetes are at greater risk of MI and stroke when compared with their single-race counterparts. Future studies should identify determinants that best explain this disproportionate burden among multiracial individuals.