Abstract 31: Impact of Acculturation on Cardiac Structure and Function Among Latinos in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL): The ECHO-SOL Ancillary Study
Authors: Lopez Lenny , Sweet Katrina , Rodríguez Fátima , Kizer Jorge R , Penedo Frank J , Gallo Linda C , Allison Matthew A , Arguelles William , Gonzalez Franklyn , Kaplan Robert , Rodríguez Carlos 
Published: July 2021

Background:
Abnormalities of cardiac structure and function are part of the spectrum of heart failure risk and progression. Acculturation is the process whereby an individual adopts the beliefs and practices of a host culture. Increasing acculturation has been associated with increased psychosocial stress and the adoption of deleterious health behaviors. The extent to which acculturation contributes to cardiovascular disease among Latinos is not well defined, and its association with cardiac structure and function in particular has not been studied among Latinos.

Hypothesis:
We hypothesized that higher acculturation is associated with worse left ventricular structure and function.

Methods:
The HCHS/SOL cohort included 16,415 Latino adults age 18-74 years from Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American backgrounds. A random subsample of 1350 also underwent detailed echocardiographic assessment for the following primary outcome measures: left atrial volume index (LAVI), left ventricular mass index (LVMI) and LV ejection fraction (LVEF), LV end diastolic volume (LVEDV) and diastolic dysfunction (Grade 0 vs. Grade 1-3). Acculturation was measured by length of residence in the US categorized as (< 5 years, 5-10 years, >10 years). Chi-square and ANOVA were used to assess differences across acculturation level and dependent variables. Separate linear and logistic regression analyses were used with sequential modeling for age and sex followed by models including diabetes, hypertension, body mass index, tobacco use, and estimated glomerular filtration rate.

Results:
The mean age of the Echocardiographic Cohort was 56 years (S.D. ±0.5). Length of residence among first generation immigrants (n=1239) was as follows: 9.7% ≤ 5 years; 14.8% 5-10 years; and 75.5% ≥10 years. Fully adjusted models demonstrated abnormal cardiac structure was significantly higher with increasing years of US residence: increasing LAVI (1.6 ml/m
2
higher ≥10 years vs. ≤ 5 years), increasing LVEDV (5.6 ml higher ≥10 years vs. ≤ 5 years), and LVMI (4.9g/m
2
higher ≥10 years vs. ≤ 5 years) (p<0.01 each). Increasing length of residence in the US was also associated with higher prevalence of diastolic dysfunction in models adjusted for age and gender (54.2% ≤ 5 years vs. 63.7% ≥10 years; p=0.04), though this became marginally non-significant in our fully adjustment models (p=0.07). There were no significant differences in systolic cardiac function as measured by LVEF.

Conclusions:
Among a diverse Latino population, higher acculturation defined as greater length of residence in the US, a proxy measure for acculturation, was associated with larger LA volume, larger LV cavity, higher LV mass and a tendency to higher prevalence of diastolic dysfunction independent of traditional risk factors. Acculturation may be a significant process that impacts cardiac structure and function among Latinos.