Isle heart ills
lowest in U.S.

Experts say the men's study
would be more useful if subgroups
of ethnicity were examined

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By Helen Altonn
haltonn@starbulletin.com

Hawaii has one of the lowest heart disease death rates for men in the country, according to a new study, but the disease is still the state's No. 1 medical killer among men.

"More people die of heart disease (in Hawaii) than AIDS, cancer and pneumonia all together," said Don Weisman, spokesman for the American Heart Association's Hawaii affiliate.

Roughly 40 percent of deaths here are cardiovascular-related, he said.

Weisman said data in the 231-page study, "Men and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality," is not very useful to Hawaii's health organizations because it does not look at ethnic subgroups.

The study, produced by the Centers for Disease Control and Prevention and West Virginia University, looks at heart disease deaths among Caucasian, African American, Hispanic and Asian-Pacific Islander men.

It looks at 1.7 million deaths of men over age 35 from heart disease between 1991 and 1995, down to city and county level. A similar report was produced last year on women.

Hawaii, Utah and Colorado had the lowest rates of heart deaths across all racial and ethnic groups.

Those with the highest death rates were Mississippi, West Virginia and Kentucky. Wherever black men live, they are more likely than whites or Hispanics to be among the 356,000 American men who die of heart disease every year, the study shows.

"Nationally we rank well," Weisman said. "We're always in the top three for the lowest incidence of death of heart disease on an annual basis."

But about 70 percent of Hawaii's people fall in the Asian-Pacific Islander category, and some subgroups have serious cardiac problems, he said.

Native Hawaiians and Filipinos have a higher risk than other ethnic groups in Hawaii for heart disease, he said.

"Until they start looking at those ethnic groups specifically, it doesn't give us anything to work on."

Weisman said the affiliate is trying to focus on those high-risk populations, but the federal disease center only looks at major minority or ethnic groups.

Cardiologist William Dang Jr. also pointed out that while Hawaii's mortality rate for cardiac disease is lower than the national average, it is higher than the national average for Hawaiians.

"There are some unique things in Hawaii," Dang said, pointing out that the diabetes rate is climbing for all of the United States and is very high for certain ethnic groups, particularly native Hawaiians and Filipinos.

"Diabetes itself is a significant disease factor for cardiac disease," he said.

"We're just starting to look at the breakdown for some subgroups in Hawaii, Filipinos vs. some Oriental groups and especially native Hawaiians."

Dang said a number of hospitals are participating in a registry for patients with heart attacks, recording data to distinguish differences in mortality.

For example, they are looking at whether certain groups are likely to get the right diagnosis or have a different threshold for when they go to see the doctor, he said.

He said the Clinton administration made a lot of funding available for analysis of diseases among racial subgroups.

Commenting on the new atlas, Dr. George Mensah, chief of the federal disease center's Cardiovascular Health program, said: "We all know that personal choices like not smoking and a healthy diet and getting exercise are critical factors in helping to prevent disease.

"But what we have not addressed is how a person's environment has an impact on those same risk factors. It makes a big difference whether you live someplace that has the networks in place that help support those personal decisions."

"If you look at the overall picture, we're doing things better than the rest of the country," Weisman said.

"More people are exercising because of year-round nice weather. They're probably eating healthier overall, with a combination of Eastern and Western mix. But there is obesity here as much as anywhere else."

Smoking is another big factor in heart disease, Weisman said, and Hawaii now ranks second or lowest in the nation for smoking. He said 18 percent of adults in the islands smoke compared with a national average of more than 20 percent.

Still, he emphasized, "The thing we're trying to get across, even though our rates are lower on an average than the mainland, heart disease still is the No. 1 killer here."