OBJECTIVES: It is important to examine cardiovascular disease(CVD) risks for patients with Alzheimer’s disease. Hawaii has the most diverse ethnic population in the US and there exist significant racial health disparities. E.g., Native Hawaiians/Pacific Islanders (NHPI) are well-known as a high-risk group for a variety of conditions, including CVD conditions. In this work, we explored the CVD risks for Hawaii AD patients based on the Medicare data, focusing on racial disparities.

METHODS: 9 years of Medicare data were used to gather information on developing AD and then progression to heart failure(HF), ischemic heart disease(IHD), atrial fibrillation(AF), acute myocardial infarction(AMI), and stroke, followed by the progressive multistate model. Covariate-matched control groups without AD were identified using the propensity score matching to compare the cardiovascular risk after AD development. Next, racial effects were tested on CVD risks while accounting for multiple risk factors.

RESULTS: We found increased risks for AMI (RR=1.95,p<0.001), HF (RR=1.41,p<0.001), and IHD (RR=1.39,p<0.001), for AD patients compared to controls. However, no elevated risks were found for AF and stroke among AD patients. Socio-economic(SE) status was found to critical factor in CVD risk. Among the low SE group, NHPI AD patients had increased risks for HF (RR=1.47 p=0.002) and IHD (RR=2.26,p=0.001), compared to whites. Also, HF risk for NHPI patients was larger compared to Asians (RR=2.08,p<0.001) as well. But they had a reduced risk for stroke (RR=0.56, p=0.008) compared to whites, and reduced risk for AF compared to both whites (RR=0.49,p<0.001) and Asians (RR=0.49,p=0.005). In the high SE group, AD NHPI patients had reduced risks for HF (RR=0.45, p<0.001), compared to whites, and AF compared to Asians (RR=0.48,p=0.013).

CONCLUSIONS: This study suggests AMI, HF, and IHD risk among AD subjects, and there exist significant racial disparities mediated by the SE status in Hawaii.