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The Strong Heart Study. A study of cardiovascular disease in American Indians: design and methods
E T Lee1, T K Welty, R Fabsitz
1Dept. of Biostatistics and Epidemiology, U. of Oklahoma Health Sciences Center, Oklahoma City 73190.
Insights
Cardiovascular disease is the leading cause of death for American Indians. The Strong Heart Study investigates its prevalence, incidence, and risk factors in this population using standardized methods.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Research
Background:
- Cardiovascular disease (CVD) is the primary cause of mortality among American Indians.
- Existing data on CVD incidence, prevalence, and risk factors in this demographic are limited and often inconsistent.
- Geographic and methodological variations in previous studies hinder a comprehensive understanding of CVD in American Indians.
Purpose of the Study:
- To estimate cardiovascular disease (CVD) mortality and morbidity rates in American Indians.
- To determine the prevalence of known and suspected CVD risk factors within this population.
- To examine the associations between CVD and various risk factors using standardized methodology.
Main Methods:
- The Strong Heart Study employed a standardized methodology across 12 American Indian tribes in Arizona, Oklahoma, and the Dakotas.
- A mortality survey (1984-1988) assessed CVD deaths in individuals aged 35-74.
- A morbidity survey (1984-1988) and a clinical examination of 4,500 individuals (aged 45-74) evaluated CVD incidence, prevalence, and risk factors.
Main Results:
- The study assessed risk factors including family history, diet, alcohol and tobacco use, physical activity, acculturation, and socioeconomic status.
- Clinical examinations included measurements of body composition, blood pressure, cardiac and pulmonary function, peripheral vascular disease, and electrocardiograms.
- Laboratory analyses covered glucose, insulin, lipids, apoproteins, fibrinogen, glycated hemoglobin, and renal function markers. DNA was collected for future genetic studies.
Conclusions:
- The Strong Heart Study provides crucial, standardized data on cardiovascular disease (CVD) burden in American Indians.
- Findings are essential for understanding CVD etiology and developing targeted prevention and treatment strategies for this population.
- The study establishes a foundation for future research, including genetic analyses, to further elucidate CVD risk in American Indians.
Abstract:
Available data indicate that cardiovascular disease has become the leading cause of death in American Indians. However, limited information is available on cardiovascular disease incidence, prevalence, and risk factors in this population. Reported cardiovascular disease rates vary greatly among groups in different geographic areas. These rates have been obtained from studies of varying sizes and different methodologies. The Strong Heart Study, which uses standardized methodology, is designed to estimate cardiovascular disease mortality and morbidity rates and the prevalence of known and suspected cardiovascular disease risk factors in American Indians. The study population consists of 12 tribes in three geographic areas: an area near Phoenix, Arizona, the southwestern area of Oklahoma, and the Aberdeen area of North and South Dakota. The study includes three components. The first is a mortality survey to estimate cardiovascular disease mortality rates for 1984-1988 among tribal members aged 35-74 years, and the second is a morbidity survey to estimate incidence of both first and first or recurrent hospitalized myocardial infarction and stroke (cerebrovascular disease) among tribal members aged 45-74 years in 1984-1988, and the third is a clinical examination of 4,500 tribal members aged 45-74 years in order to estimate the prevalence of cardiovascular disease and its associations with risk factors. Family history, diet, alcohol and tobacco consumption, physical activity, degree of acculturation, and socioeconomic status are assessed in personal interviews. The physical examination includes measurements of body fat, body circumferences, and blood pressure, an examination of the heart and lungs, an evaluation of peripheral vascular disease, and a 12-lead electrocardiogram. Laboratory measurements include fasting and postload glucose, insulin, fasting lipids, apoproteins, fibrinogen, and glycated hemoglobin. Also measured are serum and urine creatinine and urinary albumin. DNA from lymphocytes is isolated and stored for future genetic studies.