To our knowledge, this is the first in-depth report of a population-based survey of cardiovascular risk factors and knowledge of symptoms of heart attack and stroke among Vietnamese Americans. Compared with non-Hispanic whites in California, Vietnamese Americans reported lower prevalences of obesity, diabetes mellitus, coronary heart disease, and hypertension, similar prevalences of hypercholesterolemia and stroke, lower frequency of fruit and vegetable intake, and higher rates of physical inactivity and, among men, cigarette smoking. Among Vietnamese Americans, those who responded in the Vietnamese language were more likely to eat fruits and vegetables less frequently on a daily basis, engage in no moderate or vigorous physical activity, and, among men, be current smokers.
Some studies have reported that Asians suffer from obesity-related problems at a lower BMI cutoff than the usual standards.29,30
In this study, compared to non-Hispanic whites, Vietnamese Americans had a much lower prevalence of obesity, but a similar prevalence of hypercholesterolemia and only slightly lower prevalences of diabetes mellitus and hypertension. Higher BMI has been shown to be associated with US birthplace in Asian-American populations.31
We did not measure birthplace, but there was no difference in BMI between Vietnamese Americans who responded in Vietnamese or in English.
Physical inactivity is an important cardiovascular risk factor, and 40% of Vietnamese Americans, compared to 12% of non-Hispanic whites, did not engage in any moderate or vigorous activity. Physical activity measures in this study included walking, gardening, and other activities that raise the heart rate, as well as typical exercise, such as running. Thus, cultural differences in activities that constitute exercise are unlikely explanations for this difference. Little has been published about how Vietnamese Americans view exercise or what type of activity would engage them. We did find here that those who spoke Vietnamese were slightly less likely to report adequate physical activity. Thus, more research is needed to delineate the barriers and interventions needed to promote exercise among this population.
Cigarette smoking is another important risk factor for cardiovascular diseases. Smoking prevalence in the general male population of California have declined from 28.2% in 1985 to 17.0% in 2005.32
However, the prevalence among Vietnamese men in Santa Clara County, California, has barely declined, from 35% in 199633
to 31.2% in 200122
to 29.8% in this study. This slight decline has occurred despite the availability of a toll-free quitline with Vietnamese-language capability, multimedia campaigns in the Vietnamese language, and medications to treat nicotine addiction.34,35
Clearly, new approaches, which may have to be more directed and intensive, are needed to reduce smoking among men in this population. Efforts should also be made to maintain the low rates of smoking among Vietnamese-American women since there may be a rise in smoking with acculturation among Asian Americans.36
Vietnamese Americans may not meet the Healthy People 2010 recommendations for fruit and vegetable consumption (75% with at least two daily servings of fruit and 50% with at least three daily servings of vegetables).37
This finding is rather surprising, because the typical Vietnamese diet is high in carbohydrates and low in fat38
, and Vietnamese Americans report a strong preference for fruits and vegetables.39
Measurement problems may underlie this finding. Five of the six items in the questionnaire ask for “times” rather than “servings,” and it is possible that Vietnamese Americans may eat more than one serving of fruit or vegetables at a time. It is important for future studies of nutrition among Vietnamese and Asian Americans to assess the best method to collect accurate dietary intake data.
Another problem identified by this study is the lack of knowledge of heart attack and stroke symptoms. Recognition of these symptoms is important, because early treatment can save lives and prevent morbidity. Only 59% of Vietnamese Americans in this study knew that chest pain was a symptom for heart attack, compared to 95% of Americans in the 2001 BRFSS.28
In our study, there was no differences in knowledge of symptoms between English-speaking and Vietnamese-speaking Vietnamese Americans. An educational campaign targeting Vietnamese Americans in both languages about the symptoms of heart attack and stroke may be needed.
The findings in this report are subject to some limitations. Persons without telephones and those who used only cell phones were not included in the survey. Because estimates were based on self-reported data, the prevalence of certain chronic conditions might be under- or overestimated. Although most of the measures included in this report have high or moderate reliability and validity,40
they have not been evaluated in Vietnamese populations.
Our study shows that the self-reported prevalences of cardiovascular diseases are somewhat lower among Vietnamese Americans than among non-Hispanic whites. However, Vietnamese Americans have significant disparities in cardiovascular risk factors, such as physical inactivity and cigarette smoking among men, as well as in knowledge of heart attack and stroke symptoms. It is likely that, in the absence of change, the rates of adverse cardiovascular outcomes, such as heart attacks and strokes, will rise. The findings from this study underscore a need for further research into understanding the determinants of cardiovascular risk factors and into developing culturally appropriate interventions to address them in this understudied population.