Exploring the cardiovascular disease risk factors in migrant workers with acute coronary syndrome
When Ajay, a 48-year-old Indian software engineer, collapsed with a heart attack just months after arriving in the United States, his doctors were puzzled. How could someone with no prior health concerns, who had passed his pre-migration medical with flying colors, suddenly become a cardiac patient?
Ajay's case illustrates what scientists call the "healthy immigrant effect"—a phenomenon where new immigrants often arrive healthier than the native-born population but gradually lose this health advantage over time 1 . For cardiovascular health, this paradox is particularly striking. Recent research presented at the American College of Cardiology's Middle East 2025 conference reveals that while newly arrived immigrants have lower rates of hypertension, high cholesterol, and smoking compared to U.S.-born residents, these protective factors diminish the longer they live in their new country 1 9 .
International migrants worldwide in 2020
Years until health advantage typically fades
An umbrella term for situations where blood supply to the heart muscle is suddenly blocked, including heart attacks and unstable angina.
Immigrants often arrive with better health indicators than native-born populations but gradually lose this advantage over time 6 .
Migrant workers face a constellation of traditional and migration-specific risk factors that contribute to ACS development.
| Risk Factor Category | Specific Examples | Impact on CAD Risk |
|---|---|---|
| Non-modifiable | Age (especially >35 years), Male gender, Family history of premature CAD | Captures 63-80% of predictive performance for CAD |
| Modifiable Medical | Hypertension, Diabetes, Hyperlipidemia | Controlling these leads to substantial reductions in CAD events |
| Lifestyle Factors | Smoking, Poor diet, Sedentary behavior, Obesity | Obese patients are twice as likely to have coronary heart disease |
To understand how migration impacts cardiovascular health, let's examine the groundbreaking research presented at the ACC Middle East 2025 conference that analyzed risk factors in nearly 16,000 adults 1 9 .
Researchers divided participants into U.S.-born and foreign-born groups, then further segmented foreign-born individuals by length of U.S. residence (less than 15 years vs. more than 15 years).
The team focused on five key cardiovascular disease risk factors: body mass index (BMI), diabetes, hypertension, dyslipidemia (abnormal cholesterol levels), and smoking status.
Using statistical models, researchers adjusted for potential confounding factors to isolate the effect of immigration status and duration of residence on cardiovascular risk.
The study paid special attention to ethnic subgroups, including non-Hispanic Asian immigrants, who have been identified as particularly high-risk for certain cardiovascular conditions 2 .
The findings revealed a clear pattern of deteriorating cardiovascular health among long-term immigrants:
Foreign-born participants with at least one CVD risk factor
U.S.-born adults with at least one CVD risk factor
Diabetes prevalence in foreign-born non-Hispanic Asian adults
| Barrier Category | Specific Challenges | Impact on Cardiovascular Health |
|---|---|---|
| Healthcare System Barriers | Lack of familiarity with system navigation, Language barriers, Gaps in health insurance | Delayed diagnosis and treatment of risk factors |
| Social Determinants | Financial hardship, Unemployment, Occupational stress | Increased allostatic load and chronic stress |
| Cultural & Linguistic | Discrimination, Cultural conflicts, Loss of community support | Erosion of protective health behaviors and social buffers |
Scales and indices that quantify how much immigrants have adopted the host country's cultural norms, behaviors, and values.
Standardized measurements including blood pressure monitoring, cholesterol panels, HbA1c tests for diabetes, and BMI calculations 2 .
Multisystem biomarkers including stress hormones, inflammatory markers, and cardiovascular markers that measure the body's cumulative stress burden 2 .
"Immigrants should proactively protect their health through screenings and maintaining protective behaviors, while clinicians must recognize duration of U.S. residence as a risk factor and provide culturally tailored prevention strategies."
From the same cultural background who can bridge the gap between traditional and Western healthcare systems 2 .
Culturally appropriate guidance that incorporates traditional healthy foods while educating about Western food risks.
Programs that address migration-specific stressors like family separation and discrimination.
Healthcare providers should consider length of residence as a meaningful factor in immigrant patients' risk profiles and emphasize early screenings 9 .
Efforts to improve housing, working conditions, and social support for migrant workers can reduce allostatic load and cardiovascular risk 2 6 .
Removing language barriers, increasing cultural competence among providers, and creating welcoming healthcare environments can improve access and utilization 6 .
The fading cardiovascular health advantage among immigrants represents both a challenge and an opportunity. As one researcher noted, "Immigrants arrive with a cardiovascular health advantage, but this fades the longer they reside in the U.S. due to acculturation, stress and lifestyle changes" 9 .
The silver lining is that this decline is not inevitable. Through culturally tailored interventions, improved healthcare access, and supportive policies, we can help migrant workers preserve their initial health advantage. Protecting the heart health of those who contribute so much to our economies and communities isn't just good medicine—it's a societal imperative.
For migrant workers like Ajay, understanding these risks and implementing protective strategies could mean the difference between a sudden cardiac event and a long, healthy life in their new home. The goal isn't just to treat acute coronary syndrome when it occurs, but to prevent it from happening in the first place.