Arab American adults demonstrated substantial cardiometabolic and ASCVD burden, with premature ASCVD characterized by clustering of hyperlipidemia, hypertension, smoking, and elevated body mass index, supporting improved ethnicity data collection and earlier, more intensive risk-factor management in this under-recognized population.
Key Findings
Results
Among 49,440 Arab American adults in a large U.S. health care system, 15.2% had ASCVD and 3.4% had premature ASCVD.
The study population consisted of 49,440 Arab American adults drawn from the Houston Methodist Cardiovascular Disease Learning Health System Registry (2016-2025).
The cohort was 53.1% women with a median age of 44 years.
Arab American individuals were identified using a validated Arab name algorithm.
Premature ASCVD was defined as a distinct category separate from overall ASCVD prevalence.
Results
Hyperlipidemia and hypertension were the strongest correlates of overall ASCVD in Arab Americans.
Hyperlipidemia had an odds ratio of 3.36 (95% CI: 3.13-3.61) for overall ASCVD.
Hypertension had an odds ratio of 3.14 (95% CI: 2.91-3.39) for overall ASCVD.
Associations were identified through multivariable logistic regression models.
Sex-stratified models were also evaluated as part of the analysis.
Results
Hyperlipidemia and hypertension showed even stronger associations with premature ASCVD than with overall ASCVD.
Hyperlipidemia had an odds ratio of 4.18 for premature ASCVD, compared to 3.36 for overall ASCVD.
Hypertension had an odds ratio of 3.88 for premature ASCVD, compared to 3.14 for overall ASCVD.
Premature ASCVD was also characterized by clustering of smoking and elevated body mass index.
These stronger associations suggest risk factor burden is particularly impactful in younger individuals developing ASCVD.
Results
Sex differences were observed in the associations of specific risk factors with premature ASCVD among Arab Americans.
Hyperlipidemia was more strongly associated with premature ASCVD in men.
Hypertension showed stronger associations with premature ASCVD in women.
Diabetes showed stronger associations with premature ASCVD in women.
These findings were derived from sex-stratified multivariable logistic regression models.
Results
Cardiometabolic conditions increased with age and were generally more prevalent in men, with the exception of obesity.
Age- and sex-specific prevalence was estimated for diabetes, hypertension, dyslipidemia, obesity, chronic kidney disease, and ASCVD.
Cardiometabolic conditions assessed included diabetes, hypertension, dyslipidemia, obesity, and chronic kidney disease.
Obesity was the sole cardiometabolic condition that was not more prevalent in men compared to women.
The pattern of increasing prevalence with age was consistent across cardiometabolic conditions.
Background
Arab Americans remain under-represented in U.S. cardiovascular research due to the absence of a dedicated Middle Eastern and North African ethnicity identifier in registries.
U.S. registries frequently classify Arab Americans as 'White,' obscuring their distinct cardiometabolic and ASCVD burden.
The study used a validated Arab name algorithm to identify Arab American individuals as a proxy for ethnicity identification.
The authors note that improved ethnicity data collection is needed for this population.
The SALAM Registry represents an effort to characterize cardiovascular risk in this under-recognized group.
What This Means
This research used records from over 49,000 Arab American adults in a major Houston hospital system to understand their heart disease risk. Because Arab Americans are typically grouped with White Americans in health databases, little was previously known about their specific cardiovascular health. The researchers identified Arab Americans using a name-recognition algorithm and found that 15.2% had established cardiovascular disease and 3.4% had developed it at a young age (premature cardiovascular disease). High cholesterol and high blood pressure were the strongest risk factors linked to heart disease in this group, and these associations were even stronger for those who developed heart disease early in life.
The study also found notable differences between men and women. Most heart disease risk factors were more common in men, but obesity was more common in women. When looking specifically at early-onset heart disease, high cholesterol was a bigger risk factor for men, while high blood pressure and diabetes were more strongly linked to early heart disease in women. These patterns suggest that risk factor management may need to be tailored differently by sex within this population.
This research suggests that Arab Americans carry a significant and previously underappreciated burden of heart disease and its risk factors. The findings highlight the need for better ethnic data collection in health systems — currently Arab Americans are often recorded simply as 'White,' which hides important health disparities. Earlier and more intensive management of risk factors like high cholesterol, high blood pressure, smoking, and obesity may be especially important for Arab American patients, particularly for preventing heart disease at younger ages.
Jad Ardakani, I. Shahid, H. Saleem, Ahmed Abdou, Aditya Siddharth, Budhaditya Bose, et al.. (2026). Cardiometabolic and ASCVD Risk Profiles in Arab Americans: Insights From the SALAM Registry.. JACC: Advances. https://doi.org/10.1016/j.jacadv.2026.103202