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Rising tide of cardiovascular disease in American Indians. The Strong Heart Study
B V Howard1, E T Lee, L D Cowan
1Medlantic Research Institute and Washington Hospital Center, Washington, DC, USA. bvh1@mhg.edu
Insights
Cardiovascular disease (CVD) and coronary heart disease (CHD) rates are increasing in American Indians, exceeding other US populations. High diabetes prevalence is a key factor, necessitating aggressive risk factor control programs.
Area of Science:
- Epidemiology
- Cardiovascular Disease Research
- American Indian Health
Background:
- Cardiovascular disease (CVD) historically rare in American Indians, now shows increasing mortality.
- Significant geographic and community variations in CVD mortality rates observed.
- The Strong Heart Study initiated to investigate CVD and risk factors in American Indian communities.
Purpose of the Study:
- To investigate the incidence and risk factors of cardiovascular disease (CVD) in American Indian populations.
- To compare CVD and coronary heart disease (CHD) rates in American Indians with other US ethnic groups.
- To identify predictors of CVD morbidity and mortality in American Indian men and women.
Main Methods:
- Longitudinal study of 4549 American Indian participants (aged 45-74) from 1989-1995.
- Baseline examination followed by surveillance and a second examination for surviving participants.
- Medical records reviewed to ascertain nonfatal cardiovascular events and determine causes of death.
Main Results:
- CVD morbidity and mortality rates were higher in men than women, and consistent across three geographic areas.
- Coronary heart disease (CHD) incidence rates in American Indians were nearly double those in the Atherosclerosis Risk in Communities Study.
- Independent predictors of CVD included diabetes, age, LDL cholesterol, albuminuria, and hypertension; obesity was an inverse predictor in women.
Conclusions:
- American Indians exhibit higher and potentially more fatal CHD rates than other US populations.
- Increasing CHD incidence in American Indians may be linked to high diabetes prevalence.
- Aggressive programs targeting diabetes and its risk factors are crucial to mitigate rising CVD rates.
Background:
Although cardiovascular disease (CVD) used to be rare among American Indians, Indian Health Service data suggest that CVD mortality rates vary greatly among American Indian communities and appear to be increasing. The Strong Heart Study was initiated to investigate CVD and its risk factors in American Indians in 13 communities in Arizona, Oklahoma, and South/North Dakota.
Methods And Results:
A total of 4549 participants (1846 men and 2703 women 45 to 74 years old) who were seen at the baseline (1989 to 1991) examination were subjected to surveillance (average 4.2 years, 1991 to 1995), and 88% of those remaining alive underwent a second examination (1993 to 1995). The medical records of all participants were exhaustively reviewed to ascertain nonfatal cardiovascular events that occurred since the baseline examination or to definitively determine cause of death. CVD morbidity and mortality rates were higher in men than in women and were similar in the 3 geographic areas. Coronary heart disease (CHD) incidence rates among American Indian men and women were almost 2-fold higher than those in the Atherosclerosis Risk in Communities Study. Significant independent predictors of CVD in women were diabetes, age, obesity (inverse), LDL cholesterol, albuminuria, triglycerides, and hypertension. In men, diabetes, age, LDL cholesterol, albuminuria, and hypertension were independent predictors of CVD.
Conclusions:
At present, CHD rates in American Indians exceed rates in other US populations and may more often be fatal. Unlike other ethnic groups, American Indians appear to have an increasing incidence of CHD, possibly related to the high prevalence of diabetes. In the general US population, the rising prevalence of obesity and diabetes may reverse the decline in CVD death rates. Therefore, aggressive programs to control diabetes and its risk factors are needed.
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