Cardiometabolic and ASCVD Risk Profiles in Arab Americans: Insights From the SALAM Registry

Arab Americans remain under-represented in U.S. cardiovascular research because registries lack a dedicated Middle Eastern and North African ethnicity identifier and frequently classify Arab Americans as "White." Their cardiometabolic and atherosclerotic cardiovascular disease (ASCVD) burden remains poorly characterized.

The objective of the study was to characterize ASCVD and premature ASCVD prevalence and quantify traditional cardiovascular risk factor associations among Arab Americans in a large U.S. health care system.

Adults ≥18 years in the Houston Methodist Cardiovascular Disease Learning Health System Registry (2016-2025) were analyzed. Arab American individuals were identified using a validated Arab name algorithm. Age- and sex-specific prevalence of diabetes, hypertension, dyslipidemia, obesity, chronic kidney disease, and ASCVD was estimated. Multivariable logistic regression, including sex-stratified models, evaluated associations of traditional risk factors with overall and premature ASCVD.

Among 49,440 Arab American adults (53.1% women; median age, 44 years), 15.2% had ASCVD and 3.4% had premature ASCVD. Cardiometabolic conditions increased with age and were more prevalent in men, except for obesity. Hyperlipidemia (OR: 3.36; 95% CI: 3.13-3.61) and hypertension (OR: 3.14; 95% CI: 2.91-3.39) were the strongest correlates of ASCVD, with stronger associations for premature ASCVD (OR: 4.18 and 3.88, respectively). Hyperlipidemia was more strongly associated with premature ASCVD in men, whereas hypertension and diabetes showed stronger associations in women.

Arab American adults demonstrated substantial cardiometabolic and ASCVD burden, with premature ASCVD characterized by clustering of hyperlipidemia, hypertension, smoking, and elevated body mass index. These findings support improved ethnicity data collection, and earlier, more intensive risk-factor management in this under-recognized population.