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Coronary heart disease prevalence and its relation to risk factors in American Indians. The Strong Heart Study
B V Howard1, E T Lee, L D Cowan
1Medlantic Research Institute, Washington, DC 20010-2933, USA.
Insights
Coronary heart disease (CHD) is a leading cause of death for American Indians. The Strong Heart Study found diabetes is the strongest risk factor for CHD in this population, emphasizing the need for targeted interventions.
Area of Science:
- Cardiovascular epidemiology
- Native American health
- Metabolic disease research
Background:
- Coronary heart disease (CHD) is the primary cause of mortality among American Indians, yet data on its prevalence and associated risk factors are scarce.
- The Strong Heart Study was established to address this knowledge gap by investigating cardiovascular disease and risk factors in diverse American Indian communities.
Purpose of the Study:
- To quantify the prevalence of CHD and its relationship with established cardiovascular risk factors among American Indians.
- To identify specific risk factors contributing to CHD in this population, with a focus on diabetes mellitus.
Main Methods:
- A cross-sectional study involving physical examinations, medical histories, electrocardiograms, and laboratory tests (including lipids, glucose, insulin, and albumin) in 13 American Indian communities.
- Participants aged 45-74 years from Arizona, Oklahoma, and the Dakotas were assessed.
- Logistic regression analysis was used to determine independent predictors of prevalent CHD.
Main Results:
- Prevalence rates of myocardial infarction and CHD were higher in men than women and significantly elevated in individuals with diabetes mellitus.
- Diabetes was a stronger risk factor for CHD in women than in men.
- CHD prevalence was lowest in Arizona communities, despite higher rates of diabetes, obesity, and hypertension, potentially due to lower smoking rates and lipid levels.
Conclusions:
- Diabetes mellitus is identified as the most significant risk factor for CHD among American Indians, surpassing other known factors.
- The study highlights the critical role of diabetes and associated variables in CHD development within Native American populations.
- Distinctive patterns of CHD prevalence, particularly the lower rates in Arizona, warrant further investigation into protective factors like reduced smoking and favorable lipid profiles.
Abstract:
Although coronary heart disease (CHD) is currently the leading cause of death among American Indians, information on the prevalence of CHD and its association with known cardiovascular risk factors is limited. The Strong Heart Study was initiated in 1988 to quantify cardiovascular disease and its risk factors among three geographically diverse groups of American Indians. Members of 13 Indian communities in Arizona, Oklahoma, and South and North Dakota between 45 and 74 years of age underwent a physical examination that included medical history; an electrocardiogram; anthropometric and blood pressure measurements; an oral glucose tolerance test; and measurements of fasting plasma lipoproteins, fibrinogen, insulin, hemoglobin A1c, and urinary albumin. Prevalence rates of definite myocardial infarction and definite CHD were higher in men than in women at all three centers (p < 0.0001) and higher in those with diabetes mellitus (p = 0.002 in men and p = 0.0003 in women). Diabetes was associated with relatively higher prevalence rates of myocardial infarction (diabetic:nondiabetic prevalence ratio = 3.8 vs. 1.9) and CHD (prevalence ratio = 4.6 vs. 1.8) in women than in men. Prevalence rates of heart disease were lowest in the communities in Arizona; prevalence rates were similar in Oklahoma and South Dakota/North Dakota and were two- to threefold higher than those in Arizona. By logistic regression, prevalent CHD among American Indians was significantly and independently related to age, diabetes, hypertension, albuminuria, percentage of body fat, smoking, high concentrations of plasma insulin, and low concentrations of high density lipoprotein cholesterol. In contrast to reports from other non-Indian populations, diabetes was the strongest risk factor. The lower prevalence of CHD among Indians in Arizona is distinctive in view of their higher rates of diabetes, obesity, hypertension, and albuminuria, but it may be partly related to their low frequency of smoking and their low concentrations of total and low density lipoprotein cholesterol. These findings from the initial Strong Heart Study examination emphasize the importance of diabetes and its associated variables as risk factors for CHD in Native American populations.