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Vol. 37. Num. 7.July 2018
Pages 549-636
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Vol. 37. Num. 7.July 2018
Pages 549-636
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DOI: 10.1016/j.repce.2018.05.008
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The phenomenon of migration and cardiovascular risk factors
O fenómeno migratório e fatores de risco cardiovascular
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Manuel Campeloa,b
a Serviço de Cardiologia, Centro Hospitalar de S. João, EPE, Porto, Portugal
b Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Migration of human populations is universal and continues to the present day.1 Migrations are frequently associated with problems of adaptation, which in turn can lead to increased cardiovascular risk.

Most developing countries do not have reliable recording systems that enable them to assess mortality rates or to quantify cardiovascular risk factors in the real world. Attempts to estimate the true burden of cardiovascular disease (CVD) in these countries, as well as to make projections of future trends, must therefore be based on local registries or on inferences using suitable data from other countries in the region.2

However, somewhat paradoxically, the burden of CVD in individuals of African descent living in the US and, to a lesser extent, in the Caribbean and the UK, has been the subject of considerable research over the last fifty years. This has shown, for example, that rates of hypertension are approximately 50% higher in African-Americans than in other races and, as a result, they suffer significantly increased mortality from stroke.3,4

There have been studies comparing hypertension in African and European populations,5 while others have demonstrated increased cardiovascular risk in immigrants to Europe.6,7 However, a search of the international literature gives the impression that this subject has been addressed more thoroughly in African-American and African groups1,2 than in European populations.

The study by Tavares et al. in this issue of the Journal8 provides an original and pioneering analysis of the cardiovascular risk profile and social integration of university students from an African country (Cape Verde) studying in Portugal, comparing them with Caucasian Portuguese students studying in Portugal and Cape Verdean students studying in their home country.

The study found signs of poor adaptation among the Cape Verdean students living in Portugal. They took less exercise, were more likely to abuse drugs, more frequently reported difficulties with integration, and showed more signs of financial difficulties than the other two groups.

The study also revealed that, even after only a short time residing as immigrants in Portugal, the African students already showed significant changes in cardiovascular risk profile, such as higher blood pressure, body weight, salt intake, aortic stiffness and albuminuria, compared to individuals born and residing in Portugal, and increases in salt intake, body weight and albuminuria compared to individuals born and residing in Cape Verde.

As the authors point out, the increased cardiovascular risk found in this population could be related to difficulties adapting to the new country and the adoption of less healthy lifestyles, which may justify early preventive measures to prevent or mitigate this increased risk.

The study has two main points of interest. Firstly, it demonstrates increased cardiovascular risk in a young population, with a life expectancy of several decades; since it is not easy to change behaviors, it can be assumed that the persistence of these risk factors over time will compromise their cardiovascular health years later, which is a concern for society.9 Secondly, the high level of education of university students might have been expected to act as a protective factor against the negative effects of a change in environment. However, this was not the case, and in fact the authors detected significant changes in the risk profile of this population after only a short stay in a foreign country.

Various social, cultural and economic factors are known to contribute to the development and persistence of health-related behavioral patterns, and to the ways in which they change. In this regard, adopting healthy behaviors and lifestyles has been shown to reduce the risk of CVD,10 for which awareness of modifiable risk factors is important, but this was not specifically addressed in the study by Tavares et al. Knowledge of cardiovascular risk factors appears to be central to changing behavior: models of health behavior show that awareness of the negative consequences of a particular behavior is a necessary (though not always sufficient) condition for changing that behavior.11–13

This aspect of patients’ knowledge should be taken into account when designing measures for the control of cardiovascular risk factors.

Overall, this work undoubtedly helps to deepen understanding of cardiovascular risk in migrants in Europe and opens the way for other studies in this area.

Conflicts of interest

The author has no conflicts of interest to declare.

References
[1]
S. Baharian,M. Barakatt,C.R. Gignoux
The Great Migration and African-American genomic diversity
PLoS Genet, 12 (2016), pp. e1006059 http://dx.doi.org/10.1371/journal.pgen.1006059
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Cardiovascular risk status of Afro-origin populations across the spectrum of economic development: findings from the Modeling the Epidemiologic Transition Study
BMC Public Health, 17 (2017), pp. 438 http://dx.doi.org/10.1186/s12889-017-4318-4
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Ethnic differences in stroke mortality between non-Hispanic whites, Hispanic whites, and blacks. The National Longitudinal Mortality Study
Stroke, 25 (1994), pp. 2120-2125
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Changes and geographic distribution of mortality from cerebrovascular disease
Am J Public Health Nations Health, 55 (1965), pp. 673-681
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All cause and cardiovascular mortality in African migrants living in Portugal: evidence of large social inequalities
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L. Tavares,C. Calhau,J. Polónia
Assessment of cardiovascular risk and social framework of Cape Verdean university students studying in Portugal
Rev Port Cardiol, 37 (2018), pp. 577-582 http://dx.doi.org/10.1016/j.repc.2017.09.027
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W. Herrington,B. Lacey,P. Sherliker
Epidemiology of atherosclerosis and the potential to reduce the global burden of atherothrombotic disease
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P.J. Elmer,E. Obarzanek,W.M. Vollmer
Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial
Ann Intern Med, 144 (2006), pp. 485-495
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Application of behavior-change theories and methods to injury prevention
Epidemiol Rev, 25 (2003), pp. 65-76
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C.J. Homko,W.P. Santamore,L. Zamora
Cardiovascular disease knowledge and risk perception among underserved individuals at increased risk of cardiovascular disease
J Cardiovasc Nurs, 23 (2008), pp. 332-337 http://dx.doi.org/10.1097/01.JCN.0000317432.44586.aa
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BMC Public Health, 5 (2005), pp. 7 http://dx.doi.org/10.1186/1471-2458-5-7

Please cite this article as: Campelo M. O fenómeno migratório e fatores de risco cardiovascular. Rev Port Cardiol. 2018;37:583–584.

Copyright © 2018. Sociedade Portuguesa de Cardiologia
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Portuguese Journal of Cardiology

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