<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_262"
                     title="Unequal Outcomes Despite Equal Treatment (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18110?impressionId=1265768314784"
                     
      &lt;p&gt;Race and income determined the likelihood of surviving liver cancer even when patients&apos; treatment appeared the same, researchers said.&lt;/p&gt;
&lt;p&gt;Data from the CDC&apos;s Surveillance, Epidemiology, and End Results (SEER) database for nearly 15,000 patients diagnosed with hepatocellular carcinoma from 1973 to 2004 found that blacks had a 15% higher death rate than whites (95% CI 9% to 22%), according to Joseph Kim, MD, of City of Hope in Duarte, Calif., and colleagues.&lt;/p&gt;
&lt;p&gt;Unadjusted five-year survival rates were about 6% for blacks, compared with about 9% for whites with liver cancer, the researchers reported online in &lt;em&gt;Cancer&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Moreover, middle and high income levels were associated with better survival than low income (hazard ratio for death 0.89 and 0.95, respectively, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.03 for both versus low income), the researchers wrote.&lt;/p&gt;
&lt;p&gt;The results reflected adjustments for types of treatments administered, such as tumor ablation or resection or liver transplantation, for tumor grade at diagnosis, and for other factors.&lt;/p&gt;
&lt;p&gt;&quot;Our study demonstrates that black patients and lower income patients continue to have the worst survival,&quot; Kim and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The findings conflict with other studies suggesting that race was not a predictor of liver-cancer survival when treatment types were taken into account.&lt;/p&gt;
&lt;p&gt;That earlier research concluded that blacks with liver cancer were less likely to undergo surgery for localized disease, and that this difference in treatment fully accounted for racial differences in survival.&lt;/p&gt;
&lt;p&gt;So Kim and colleagues also took a closer look at treatment of patients in the SEER database with localized liver tumors diagnosed since 1998.&lt;/p&gt;
&lt;p&gt;Such patients would have been most appropriate for surgery, the researchers indicated. They found that, in line with the earlier studies, blacks had the lowest rates of surgery and transplantation (31% versus 38% for whites, &lt;em&gt;P&lt;/em&gt; not reported).&lt;/p&gt;
&lt;p&gt;But among those patients receiving orthotopic liver transplant, data from the United Network for Organ Sharing (UNOS) showed that blacks had lower rates of graft survival and overall survival compared with whites and other racial-ethnic groups.&lt;/p&gt;
&lt;p&gt;(Throughout the study, Asians tended to have the best outcomes after adjusting for other factors, and Hispanics generally had similar outcomes to whites.)&lt;/p&gt;
&lt;p&gt;The hazard ratio for graft loss among blacks versus whites was 1.63 (95% CI 1.29 to 2.04) and for overall survival it was 1.66 (95% CI 1.29 to 2.12).&lt;/p&gt;
&lt;p&gt;&quot;Therefore, our study demonstrates that survival disparities by race and ethnicity cannot be explained by access issues alone, and other factors need to be considered,&quot; according to Kim and colleagues.&lt;/p&gt;
&lt;p&gt;On the other hand, they acknowledged that there could have been differences in treatment not captured in the SEER and UNOS data.&lt;/p&gt;
&lt;p&gt;Comorbidities and hepatitis C virus-related cirrhosis were also not evaluable, making it possible that black patients were generally sicker and therefore less likely to survive.&lt;/p&gt;
&lt;p&gt;In other findings from the SEER data, Kim and colleagues noted that survival rates had increased markedly over time, and in racial-ethnic and income subgroups.&lt;/p&gt;
&lt;p&gt;Relative to patients diagnosed in the 1970s, those diagnosed from 2000 to 2004 were four times as likely to survive (HR 0.25, 95% CI 0.22 to 0.28). Five-year unadjusted survival rates increased from about 2% to 15% during this span.&lt;/p&gt;
&lt;p&gt;&quot;All racial/ethnic and income groups . . . have benefited to some degree from advances in screening, diagnosis, and treatment,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Survival rates in women have been somewhat better than in men (HR for death 0.92, 95% CI 0.86 to 0.96).&lt;/p&gt;
&lt;p&gt;Patients undergoing resection or transplantation also fared much better than those not having surgery of any kind, (HR for death 0.27, 95% CI 0.25 to 0.28). Tumor ablation or destruction was also highly beneficial (HR 0.40, 95% CI 0.36 to 0.44 relative to no surgery).&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the analysis was reported.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_267"
                     title="Public-Private Divide Found in Prostate Cancer Treatment (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/HematologyOncology/ProstateCancer/tb/18118?impressionId=1265768314784"
                     
      &lt;p&gt;Treatment that men receive for prostate cancer may depend less on their condition and more on where they are treated, a new study found.&lt;/p&gt;
&lt;p&gt;Moreover, men treated by private hospitals were nearly two and a half times more likely to receive radiation therapy (OR 2.36; 95% CI 1.37 to 4.07) and more than four and a half times more likely to receive primary androgen deprivation therapy (OR 4.71; 95% CI 2.15 to 10.36) than surgery, which was the predominant treatment at county hospitals, according to findings published Jan. 25 in &lt;em&gt;Cancer&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Patients in private hospitals were also more likely to be white.&lt;/p&gt;
&lt;p&gt;&quot;This is the first study to compare prostate cancer treatments between private and public institutions, and it reveals a novel variable influencing treatment choice: healthcare venue,&quot; J. Kellogg Parsons, MD, MHS, of the University of California San Diego, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Men treated at county hospitals were significantly more likely to undergo surgery, whereas those treated by private providers were more likely to undergo radiotherapy or primary androgen deprivation, irrespective of age, race, comorbidity status, clinical tumor stage, Gleason sum, and D&apos;Amico risk stratification.&quot;&lt;/p&gt;
&lt;p&gt;&quot;A likely explanation for this imparity is that the initial provider in the county hospitals was always a urologist, whereas at the private venues the initial providers were a mix of urologists, radiation oncologists, and medical oncologists,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;In the U.S. in 2009, more than 190,000 men were diagnosed with prostate cancer and more than 27,000 men died from the disease, according to the National Cancer Institute. Although life expectancy, other illnesses, cancer severity, and patient preference may play a role in treatment choice, the common treatments for localized prostate cancer  --  surgery, radiation, and hormone therapy  --  all have pros and cons, and experts differ on which option is more effective.&lt;/p&gt;
&lt;p&gt;Parsons and colleagues explored whether treatment location might play a role in determining what therapy a patient receives. They analyzed the records of 559 men enrolled in a state-funded public assistance program for low-income patients, known as Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT), who received prostate cancer treatment between 2001 and 2006.&lt;/p&gt;
&lt;p&gt;The researchers noted that a limitation of the study was the population included in the IMPACT database -- generally patients with more severe cancer than in the general U.S. population; thus the findings may not reflect patients from other regions and socioeconomic groups.&lt;/p&gt;
&lt;p&gt;Of the participants, 315 received treatment from county hospitals and 244 received care from private facilities. No significant difference existed between the two groups in terms of age and tumor characteristics, yet the patients received varying therapies.&lt;/p&gt;
&lt;p&gt;&quot;In this economically disadvantaged cohort, prostate cancer treatments differed significantly between county hospitals and private providers,&quot; the authors wrote. &quot;These data reveal substantial variations in treatment patterns between different types of healthcare institutions that  --  given the implications for health policy and quality of care  --  merit further scrutiny.&quot;&lt;/p&gt;
&lt;p&gt;To help patients make informed decisions, develop appropriate expectations, and avoid making decisions they will regret, the authors proposed that patients with localized prostate cancer be provided access to multiple care providers so that they will be exposed to a variety of opinions and information about their disease.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers did not report specific support for this analysis but the IMPACT program is supported by the state of California.&lt;/p&gt;&lt;p&gt;The reseachers reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2390"
                     title="HPV Infection Linked to Survival in Some Head and Neck Cancers"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Oncology/OtherCancers/tb/15291?impressionId=1265768314784"
                     
      TORONTO, July 29 -- Human papillomavirus (HPV), which causes some cases of oropharyngeal cancer, also leads to a more treatable form of the disease and better outcomes for patients, researchers said.
              &lt;br&gt; 
              &lt;br&gt;Having an HPV-positive tumor was associated with significantly longer overall survival in both a retrospective analysis and a prospective clinical trial, according to Kevin Cullen, M.D., director of the Greenebaum Cancer Center of the University of Maryland in Baltimore, and colleagues.
              &lt;br&gt; 
              &lt;br&gt;The finding also helps to explain why black Americans with oropharyngeal cancer do worse than whites, the researchers said in the September issue of &lt;em&gt;Cancer Prevention Research&lt;/em&gt;.
              &lt;br&gt; 
              &lt;br&gt;At a press conference, Dr. Cullen and other experts told reporters that the finding should change practice. &quot;We are now testing for HPV, which we weren&apos;t doing even a few months ago,&quot; Dr. Cullen said.
              &lt;p&gt; 
              &lt;p&gt;HPV testing for oropharyngeal cancer patients has implications for both prognosis and treatment, he said.
              &lt;p&gt; 
              &lt;p&gt;Overall, Dr. Cullen said, blacks are known to have worse outcomes for squamous cell carcinoma of the head and neck although the reasons for the differences have not been entirely clear.
              &lt;p&gt; 
              &lt;p&gt;&quot;This is the first clue that it may be biologic rather than related to issues of access, insurance or provider attitudes.&quot;
              &lt;p&gt; 
              &lt;p&gt;Indeed, he and his colleagues found, the survival disadvantage is entirely driven by differing outcomes in oropharyngeal cancer and that difference, in turn, is driven by HPV infection.
              &lt;p&gt; 
              &lt;p&gt;The &quot;paradox,&quot; Dr. Cullen told reporters, is that &quot;HPV may cause some of these cancers, but HPV-positive cancers behave biologically very well -- they are very responsive to chemotherapy and radiation.&quot;
              &lt;p&gt; 
              &lt;p&gt;He said the virus is not protective, but instead gives rise to cancers that are more amenable to chemotherapy and radiation than are those caused by tobacco and alcohol use.
              &lt;p&gt; 
              &lt;p&gt;The black-white difference is caused by significantly lower rates of oral HPV among blacks, which may be a function of differing sexual practices, Dr. Cullen said during the press conference.
              &lt;p&gt; 
              &lt;p&gt;Acquiring an HPV infection through genital sex would tend to protect a person against a subsequent oral infection and vice versa, according to Otis Brawley, MD, chief medical officer of the American Cancer Society.
              &lt;p&gt; 
              &lt;p&gt;Dr. Brawley told reporters that there is some evidence of racial differences in sexual behavior risks, especially among teenagers. 
              &lt;p&gt; 
              &lt;p&gt;The CDC, he said, has found &quot;distinct preferences&quot; among young whites for oral sex as their initial sexual activity and among black youths for genital sex.
              &lt;p&gt; 
              &lt;p&gt;Such a difference in behavior &quot;makes a lot of sense in terms of causation,&quot; he said. 
              &lt;p&gt; 
              &lt;p&gt;In the current study, the researchers first analyzed a retrospective cohort of 106 white and 95 black patients with squamous cell carcinoma of the head and neck and found that median overall survival was 52.1 months for whites and 23.7 months for blacks.
              &lt;p&gt; 
              &lt;p&gt;The difference -- significant at &lt;em&gt;P&lt;/em&gt;=0.009 -- was due entirely to overall survival in the subgroup with oropharyngeal cancer, where whites had a median overall survival of 69.4 months and blacks just 23.7 months.
              &lt;p&gt; 
              &lt;p&gt;The difference in the oropharyngeal cancer subgroup was significant at &lt;em&gt;P&lt;/em&gt;=0.0006, but &quot;if you looked at patients with (cancer in) other sites, there was no difference at all,&quot; Dr. Cullen said.
              &lt;p&gt; 
              &lt;p&gt;To understand the effect of HPV, the researchers looked at prospectively collected tissue samples from patients taking part in the phase III multicenter TAX 324 trial of induction chemotherapy followed by concurrent chemoradiation.
              &lt;p&gt; 
              &lt;p&gt;All told, the cancers of 196 white patients and 28 black patients could be assessed for HPV status and 68 of them (28%) had HPV-positive tumors -- 59 of which (87%) were oropharyngeal.
              &lt;p&gt; 
              &lt;p&gt;For all tumor sites, median overall survival was 26.6 months for patients with HPV-negative tumors, but has yet to be reached for patients with HPV-positive oropharyngeal cancers -- a difference that yielded a hazard ratio for 5.1, which was significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001.
              &lt;p&gt; 
              &lt;p&gt;That was, Dr. Cullen said, &quot;an astounding biologic effect.&quot;
              &lt;p&gt; 
              &lt;p&gt;As in the retrospective cohort, most of the effect was caused by differences among oropharyngeal patients, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;Half of all of the analyzed oropharyngeal patients -- 59 of 119 -- were HPV positive and all but one of these patients were white. Median overall survival has yet to be reached for the HPV-positive patients but was only 20.9 months for HPV-negative patients, a difference that was again significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001.
              &lt;p&gt; 
              &lt;p&gt;In white patients, the proportion of HPV-positive tumors was nearly nine times higher than in blacks -- 66 of 196 tumors or 34% compared with one of 28 or 4%. The difference was significant at &lt;em&gt;P&lt;/em&gt;=0.0004.
              &lt;p&gt; 
              &lt;p&gt;The study makes an &quot;extremely important finding that has tremendously important public health implications,&quot; according to Scott Lippman, MD, of M.D. Anderson Cancer Center in Houston, editor of the journal.
              &lt;p&gt; 
              &lt;p&gt;&quot;It&apos;s the most important development in head and neck cancer that I&apos;ve seen in the past 30 years,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;For clinicians, Dr. Brawley said, the study &quot;will change how we practice. Everybody will now want to look at their head and neck cancers and analyze them for HPV.&quot;
              &lt;p&gt; 
              &lt;p&gt;He noted that the study implies that the apparent black-white difference in outcomes is really a difference in who is infected with HPV.
              &lt;p&gt; 
              &lt;p&gt;&quot;It&apos;s a landmark paper for two reasons,&quot; said Martin Blaser, MD, of New York University Langhorne Medical Center, an expert in the links between infectious agents and cancer.
              &lt;p&gt; 
              &lt;p&gt;First, he said, it clarifies the links between the disease and racial differences in outcomes. But the research also has implications for understanding the biology of cancer and the links with infectious agents, he added.
              &lt;p&gt; 
              &lt;p&gt;&quot;This study is important because it helps explain both cancer causation,&quot; he said, &quot; and also differences in incidence and outcome.&quot;
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by sanofi-aventis US, the State of Maryland Cigarette Restitution Fund, and the Orokawa Foundation. The researchers did not report any conflicts.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
      
    </recommendedItem>
    <recommendedItem id="20090101_19_4164"
                     title="Ethnic Disparities Persist in Melanoma Incidence and Detection (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Dermatology/SkinCancer/tb/17630?impressionId=1265768314784"
                     
      &lt;p&gt;Ethnic disparities persist in the incidence of melanoma and its stage at diagnosis, a retrospective analysis found.&lt;/p&gt;
&lt;p&gt;Melanoma incidence nationwide has been increasing at a rate of 2.4% per year, with certain groups having distinctly higher rates of annual increase. They include: &lt;ul&gt; &lt;li&gt;White women, 3.6% per year, (95% CI 2.4% to 4.8%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)&lt;/li&gt; &lt;li&gt;Hispanic women, 3.4% per year, (95% CI 0.9% to 6.4%, &lt;em&gt;P&lt;/em&gt;=0.01)&lt;/li&gt; &lt;li&gt;White men, 3% per year, (95% CI 2.2% to 3.8%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;There also has been a slight and statistically insignificant increase among Hispanic men (0.89%), but no change in rates among blacks, Shasa Hu, MD, of the University of Miami Miller School of Medicine, and colleagues wrote in the December &lt;em&gt;Archives of Dermatology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Early detection of melanoma among whites has resulted in improved survival  --  from 68% three decades ago to 92% in recent years  --  an improvement that has not been seen among minorities.&lt;/p&gt;
&lt;p&gt;Later detection and worse outcomes from melanoma have been well documented among blacks, but less was known about disparities among Hispanics, at least in part because it was not until the 1990s that the National Cancer Institute&apos;s Surveillance, Epidemiology, and End Results program classified data separately for Hispanics.&lt;/p&gt;
&lt;p&gt;However, in 1981 Florida began collecting longitudinal data on Hispanics in its cancer registry, the Florida Cancer Data System, which allowed Hu and colleagues to investigate trends in melanoma incidence and stage at diagnosis, according to ethnicity, in a large population sample.&lt;/p&gt;
&lt;p&gt;Between 1990 and 2004, 41,072 cases of melanoma were reported to the Florida registry: &lt;ul&gt; &lt;li&gt;In whites, 39,670 cases (30,413 invasive)&lt;/li&gt; &lt;li&gt;In Hispanics, 1,148 cases (897 invasive)&lt;/li&gt; &lt;li&gt;In blacks, 254 cases (220 invasive)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The highest rates of advanced melanoma, diagnosed at either regional or distant stages, were seen in blacks (26.4%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), while Hispanics had a higher proportion of advanced melanomas than whites (17.8% versus 11.6%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Blacks and Hispanics had advanced cancer odds ratios of 2.7 (95% CI 2 to 3.6) and 1.6 (95% CI 1.4 to 1.9), respectively, compared with whites.&lt;/p&gt;
&lt;p&gt;When investigators looked at temporal trends across the 15 years, they found that the proportion of cases diagnosed in situ increased significantly for all three groups (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Whites saw a steady decrease over time in the proportion of melanomas diagnosed at a distant stage, from 7.1% to 3.4% (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), but the proportion of blacks and Hispanics diagnosed at this stage decreased only slightly (&lt;em&gt;P&lt;/em&gt;=0.08 for both).&lt;/p&gt;
&lt;p&gt;The investigators concluded that the rising incidence of melanoma among Hispanics, and particularly Hispanic women, suggests that primary prevention needs to be emphasized in this group, and that the disparity in melanoma stage at diagnosis warrants greater emphasis on prevention in minorities.&lt;/p&gt;
&lt;p&gt;&quot;The results of our study should motivate the expansion of melanoma awareness and screening campaigns to the minority communities, which can ultimately alleviate the disparities in melanoma outcome in these populations,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Among the study&apos;s limitations are the fact that Hispanic ethnicity was imputed based on surnames when this information was not self-reported, and the likelihood of underreporting of in situ cases.&lt;/p&gt;
&lt;p&gt;This study &quot;adds melanoma to the list of documented health disparities in ethnic minority populations that includes asthma, cancer, diabetes, and cardiovascular disease among others,&quot; Claudia Hernandez, MD, and Robin J. Mermelstein, PhD, of the University of Illinois at Chicago, wrote in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;These disparities can be influenced by individual biological, cultural, and environmental factors, such as genetic predisposition, socioeconomic status, and ultraviolet light exposure.&lt;/p&gt;
&lt;p&gt;But disparities also can relate to healthcare system factors, such as difficulties in communication, access, and participation in research.&lt;/p&gt;
&lt;p&gt;Unless there is a major advance in treatment for advanced melanoma, increased surveillance remains the primary opportunity for decreasing the death rate, but this must be accompanied by intervention, Hernandez and Mermelstein stated.&lt;/p&gt;
&lt;p&gt;&quot;An effective education and outreach model that transcends cultural and language barriers must be formulated,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;It is important for physicians, researchers, and the general public to realize that disparities are not inevitable. All population groups deserve equal access, equal care, and an equal opportunity to enjoy good health.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The investigators reported no financial disclosures.&lt;/p&gt;&lt;p&gt;Editorialist Hernandez has been a speaker, investigator, and consultant for Genentech, Amgen, Centocor, Biogen Idec, and Abbott Laboratories, and is a Dermatology Foundation Women&apos;s Health Career Development Award recipient.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_135"
                     title="Hispanic Groups Differ in Cardiac Conditions (CME/CE)"
                     score="-0.006"
                     href="http://www.medpagetoday.com/Cardiology/Atherosclerosis/tb/17952?impressionId=1265768314784"
                     
      Different patterns of left ventricular hypertrophy and ventricular remodeling exist among Hispanic subgroups and in comparison with non-Hispanic whites and blacks, a study found.&lt;br&gt;
&lt;br&gt;After adjustment for hypertension and other variables, Hispanic subgroups had these odds ratios for left ventricular hypertrophy compared with whites, according to an online report in the&lt;em&gt; Journal of the American College of Cardiology:&lt;/em&gt; &lt;ul&gt;&lt;li&gt;Caribbean origin, OR 1.8 (95% CI 1.1 to 3)&lt;/li&gt;&lt;li&gt;Mexican origin, OR 2.2 (95% CI 1.4 to 3.3)&lt;/li&gt;&lt;li&gt;Central/South American origin, OR 1.5 (95% CI 0.7 to 3.1) &lt;/li&gt;&lt;/ul&gt;
All Hispanic subgroups also had a higher prevalence of concentric and eccentric hypertrophy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), Carlos J. Rodriguez, MD, of Columbia University in New York, and colleagues wrote.&lt;br&gt;
&lt;br&gt;Some evidence suggests that the prevalence of hypertension differs among Hispanic subgroups, but little is known about the prevalence of left ventricular hypertrophy and remodeling  --  factors that are important for cardiovascular prognosis in a population where heart disease and stroke are the leading causes of death.&lt;/p&gt;
&lt;p&gt;Rodriguez and colleagues therefore analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA) to identify patterns of prevalence, performing cardiac magnetic resonance imaging on 4,309 subjects from six U.S. locations.&lt;/p&gt;
&lt;p&gt;Participants were aged 45 to 84 and all were free of cardiovascular disease at baseline.&lt;/p&gt;
&lt;p&gt;Left ventricular hypertrophy was defined as the upper 95th percentile of indexed left ventricular mass, and left ventricular remodeling was determined by unadjusted left ventricular mass/left ventricular end-diastolic volume ratio.&lt;/p&gt;
&lt;p&gt;Among the 1,064 Hispanics in the cohort, 54% were of Mexican origin, 31% were of Caribbean origin, and 15% were of Central/South American origin.&lt;/p&gt;
&lt;p&gt;Levels of education and income were lower among Hispanics than among either whites or blacks, as was the proportion with private insurance. Among Hispanics, those of Mexican origin had higher mean body mass index and a greater prevalence of diabetes and metabolic syndrome.&lt;/p&gt;
&lt;p&gt;Non-Hispanic blacks had the highest overall prevalence of hypertension, with an unadjusted prevalence ratio of 1.6 compared with non-Hispanic whites.&lt;/p&gt;
&lt;p&gt;Among Hispanics, only those of Caribbean origin had a greater prevalence of hypertension than whites, with an unadjusted prevalence rate of 1.2 (95% CI 1.03 to 1.4).&lt;/p&gt;
&lt;p&gt;After adjustment for multiple factors, including age, sex, body mass index, and diabetes, the prevalence of hypertension remained higher among blacks. But the difference was only of borderline statistical significance for Caribbean-origin Hispanics, at 1.05 (95% CI 1 to 1.10) compared with whites.&lt;/p&gt;
&lt;p&gt;&quot;Despite the modest or absent differences in hypertension prevalence between Hispanics and non-Hispanic whites, all Hispanic subgroups had higher [left ventricular hypertrophy] prevalence than non-Hispanic whites,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;After adjustment for age and sex, Caribbean and Mexican-origin Hispanics had twice the odds of having left ventricular hypertrophy as whites.&lt;/p&gt;
&lt;p&gt;And after adjustment for other variables including body mass index and blood pressure, all Hispanic subgroups had higher percent predicted left ventricular mass than whites.&lt;/p&gt;
&lt;p&gt;Analysis of left ventricular geometry determined that all Hispanic subgroups, and particularly those of Caribbean and Mexican origin, had a greater prevalence (4%) of concentric hypertrophy than whites (1%).&lt;/p&gt;
&lt;p&gt;Concentric hypertrophy tends to be associated with worse target organ damage than either eccentric hypertrophy or concentric remodeling, according to the researchers.&lt;/p&gt;
&lt;p&gt;The finding that Hispanics of Mexican origin had a greater prevalence of left ventricular hypertrophy and left ventricular remodeling despite lower rates of hypertension was &quot;interesting and unexpected,&quot; and may relate to the elevated prevalence rates of obesity, metabolic syndrome, and diabetes in this group, the authors wrote.&lt;/p&gt;
&lt;p&gt;It is also possible that many of the Mexican-origin Hispanics with metabolic syndrome and diabetes had blood pressure higher than 130/80 mm Hg but had not been given a diagnosis of hypertension, and that determinants other than blood pressure, such as psychosocial stress, may contribute to hypertrophy.&lt;/p&gt;
&lt;p&gt;Moreover, this subgroup had significantly lower levels of hypertension treatment (27.5%) than Hispanics of Caribbean origin (38%), which may reflect factors such as access to care or medication adherence.&lt;/p&gt;
&lt;p&gt;Among the limitations of the study was the fact that MESA is not a representative sample of the larger U.S. Hispanic population. It excludes those with prevalent heart disease and therefore represents a lower-risk group.&lt;/p&gt;
&lt;p&gt;The results also may have been limited by residual confounding by body size.&lt;/p&gt;
&lt;p&gt;Nonetheless, the authors concluded that the prevalence of hypertension, left ventricular hypertrophy, and abnormal left ventricular remodeling differ across Hispanic subgroups.&lt;/p&gt;
&lt;p&gt;&quot;Our findings demonstrate that Hispanics are a [cardiovascular] high-risk group and highlight the fact that Hispanics&apos; subgroup differences need to be appreciated when considering [cardiovascular] risk.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Efforts are warranted to better recognize, understand, and address differences among Hispanic ethnic groups to prevent [cardiovascular disease] events in this large subset of the U.S. population,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The research was supported by the National Heart, Lung, and Blood Institute and by a Robert Wood Johnson faculty development program.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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