(P233) CARDIOVASCULAR OUTCOMES AMONG IMMIGRANTS AT RISK FOR VASCULAR DISEASES: INSIGHTS OF THE CARTAGENE STUDY

Background: Previous authors have described the “healthy immigrant” effect whereby immigrants have better health outcomes than native populations. Nevertheless, it is unclear whether the “healthy immigrant effect” persists in immigrants at increased risk for atherosclerotic cardiovascular diseases (ASCVD). We aimed to compare the long-term ASCVD outcomes between immigrants and non-immigrants with and without risk for ASCVD.

METHODS AND RESULTS: CARTaGENE is a population-based prospective cohort of individuals 40-69 years of age in Quebec, Canada (2009-2016). We excluded all individuals with prior ASCVD. We defined immigrants as participants who were not born in Canada.
Individuals deemed at risk for ASCVD were those who should be treated with statins, as stipulated by the Canadian Cardiovascular Society 2021 guidelines: diabetes mellitus (DM), chronic kidney disease, and dyslipidemia. The primary endpoint was defined as the time to the first occurrence of any ASCVD. ASCVD events included cardiovascular (CV) deaths, CV interventions, acute coronary syndromes, and ischemic neurological or peripheral vascular events. We performed Kaplan-Meier curves to compare the unadjusted rates of primary endpoint among immigrants and non-immigrants at risk for ASCVD. We used Cox proportional hazard models to evaluate the association of immigrant status with the risk of the primary endpoint, adjusted for traditional risk factors for ASCVD.

There were 1,988 immigrants and 9,688 non-immigrants without prior ASCVD at increased risk for the primary endpoint. The mean age was 55.5 and 56.5 years (females 38% and 44%, respectively). There were 1,155 immigrants and 6,044 non-immigrants without risk for ASCVD. Immigrants at increased risk for ASCVD had more diabetes mellitus (DM), higher low-density lipoprotein, but less active smoking, family history of myocardial infarction and hypertension than the non immigrants. The total number of ASCVD events was 109 (6.5/year) for immigrants and 652 (6.6/year) for non-immigrants at risk for ASCVD. After adjustment for risk factors for ASCVD, immigrants at risk for ASCVD had a similar risk of the primary endpoint as non-immigrants at risk for ASCVD (hazard ratio: 0.83 (95% confidence interval of 0.66-1.05). The six-year survival-free rate was 94% among individuals at risk for ASCVD (immigrants and non-immigrants) compared to 98% among individuals not at risk for ASCVD.

Conclusion: The Healthy Immigrant effect is attenuated in immigrants at risk for ASCVD compared to immigrants not at risk for ASCVD. Therefore, screening to identify those at increased risk for ASCVD and intensive risk modification should be offered to these high-risk immigrants.