Immigrant lifestyle change influences stroke risk

June 09, 2003

HONOLULU, June 9 - Modifying lifestyle and diet reduced stroke incidence among Chinese immigrants to the United States, according to a study presented at the American Heart Association's Second Asia Pacific Scientific Form.

"The incidence of stroke is higher in China than in the United States," says Jing Fang, M.D., assistant professor, department of epidemiology, Albert Einstein College of Medicine in the Bronx, New York. "But when individuals migrate to the United States, their stroke mortality is lower than in China."

A two-year study compared 134 Chinese immigrant stroke patients with 132 Chinese immigrants who had not suffered stroke. Half were men and their average age was 74.

Participants provided detailed information about behavioral characteristics, socioeconomic and medical status and changes in these factors after immigration.

The preliminary results show that changes in diet, exercise and job status after immigration reduced stroke risk in the control group.

"People in the control group were more likely to reduce the salt and sugar intake in their diet once they immigrated to the United States," Fang says. "In China, the food is very salty. Salt often is used as a preservative for fish and meat."

The high-salt diet can result in hypertension, a risk factor for stroke. When dietary habits were established from a list of 49 food items, non-stroke controls were more likely to eat fish at least three times a week (65 percent versus 49 percent) and twice as likely to eat more fish after immigration. More than half of the controls drank fruit juice at least once a week, but less than 31 percent of the stroke survivors did.

Even though meat preserved with salt could be purchased in Chinatown, Chinese immigrant non-stroke controls were more inclined to buy fresh fish and meat, Fang says.

Although exercise in the past 12 months was similar between stroke cases and controls, those in the control group were more likely to have participated in exercise 20 years earlier and to have increased the amount of exercise after immigration. Almost twice as many stroke-free immigrants increased their exercise level compared to the stroke patients.

Thirty-one percent of the controls reported better jobs in the United States compared to 21 percent of the stroke patients. Also, twice as many stroke patients thought their job status had worsened after coming to the United States compared to the controls.

Lower job status with the problems of language, communication and isolation in the Chinese community can create stress among the immigrants, Fang says. "These are all stressful factors to immigrants."

In addition, people in the control group were more likely than stroke patients to find and see a doctor regularly. Cigarette smoking and drinking alcohol were similar between the two groups.

The study is preliminary, but the researchers plan to continue following the immigrants and add more people to the study. "We would like to do more follow-up and conduct another risk behavior study not only with older immigrants, but with younger immigrants," Fang says. "If you want to do intervention, you have to know what risk factors are there."
Co-authors are Sun Hoo Foo, Cora Fung, Judith Wylie-Rosett and Michael H. Alderman.

American Heart Association

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