Midlife women undergoing the menopausal transition are at increased risk of cardiovascular risk factors, such as metabolic syndrome, and heart disease, such as heart failure or heart attacks, remains the leading cause of death among women in the U.S. However, research specifically focusing on midlife women, particularly in relation to acculturation and its impact on cardiovascular health, remains limited. This study aimed to identify latent subgroups of midlife women from four racial/ethnic groups (Hispanic, Asian, African American, White) based on their acculturation level and to examine differences in cardiovascular symptoms across these subgroups. 

This study was a secondary data analysis of 1,054 midlife women in the United States from 2007 to 2011. Cardiovascular symptom Index for midlife women included chest pain, heart palpitation, and difficulty in breathing. Aggregated acculturation score was obtained by combining five survey items (preference for food, music, customs, language ability, and ethnicity of friends). A latent profile analysis (LPA) was conducted to classify midlife women into distinct subgroups based on their acculturation level (Low Acculturation: Individuals with a high preference for food, music, and customs from their own culture, greater ability to read and write in their native language than in English, and a larger proportion of friends from their own ethnic group; High Acculturation: Individuals with equal preference for food, music, and customs from their own culture and American culture, equal ability to read and write in English and in their native language, and equal proportion of American friends and friends from their own ethnic group). Using a linear regression analysis, differences in cardiovascular symptoms were examined between the two LPA groups (high vs. low acculturation) in two racial/ethnic groups (Asian and Hispanic). The two-class solution was selected based on the BIC, entropy values, and class proportions. While the initial multiple regression analysis included the four ethnic groups (1=Hispanic, 2=Asian, 3=African American, 4=White) x class (low and high acculturation) interaction terms, only the Hispanic and Asian groups were included in the final analysis due to the limited number of African American and White groups with the acculturation level (most of them were US-born). All models were adjusted for age and menopausal status (e.g., premenopausal, perimenopausal, postmenopausal).

The low acculturation group (80.3%) showed strong cultural retention, with a preference for their own culture and same-ethnicity friends. The high Acculturation group (19.7%) reflected bicultural tendencies, with balanced cultural preferences and a mixed social circle. Compared to Asian women with low acculturation, both Asian (β = -14.77, p<0.001) and Hispanic (β = -10.82, p<0.001) women with high acculturation showed less cardiovascular symptoms. Hispanic women with low acculturation demonstrated more cardiovascular symptoms (β = 10.01, p<0.001) as compared to Asian women with low acculturation. Increased cardiovascular symptom severity were noted for both Hispanic and Asian midlife women during perimenopause (β = 11.48, p<0.001) and post-menopause (β = 29.58, p<0.001) as compared to those in pre-menopause.

This study suggests that strong retention of own culture may negatively impact cardiovascular health among Hispanic and Asian midlife women in the United States. While this study did not explore specific factors (e.g., types of diet, activity levels, etc.), the findings underscore the importance of acculturation that may potentially serve as a determinant of cardiovascular outcomes. Culturally congruent interventions for cardiovascular health promotion among diverse groups of midlife women need to consider the acculturation level in their intervention designs and development process.