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Diabetes and coronary heart disease in American Indians: The Strong Heart Study
B V Howard1, E T Lee, R R Fabsitz
1Medlantic Research Institute, Washington, DC 20010, USA.
Insights
Coronary heart disease (CHD) is a major health concern for American Indians. The Strong Heart Study found diabetes, hypertension, and obesity are significant risk factors for CHD in this population.
Area of Science:
- Cardiovascular epidemiology
- Public health
- Indigenous health research
Background:
- Coronary heart disease (CHD) is the primary cause of mortality among American Indians.
- Limited data exist on CHD prevalence and associated risk factors within this demographic.
- The Strong Heart Study was initiated to address this knowledge gap.
Purpose of the Study:
- To determine the prevalence of CHD and its risk factors in three geographically distinct American Indian communities.
- To investigate the relationship between various risk factors and CHD incidence in American Indians.
Main Methods:
- A cohort of 4,549 American Indian adults aged 45-74 years was studied across 13 communities.
- Phase I data (1989-1991) included clinical examinations and risk factor assessments.
- Statistical analyses, including logistic regression, were used to identify significant associations.
Main Results:
- Very high diabetes prevalence (33-72%) was observed across all centers.
- Higher prevalence of myocardial infarction (MI) and CHD in men compared to women, and in individuals with diabetes.
- Diabetes showed a disproportionately greater impact on CHD prevalence in women.
- Key CHD risk factors identified: age, diabetes, hypertension, albuminuria, body fat, smoking, high insulin, and low HDL cholesterol.
- Lower CHD rates in Arizona were linked to reduced smoking and lower cholesterol levels despite higher rates of other risk factors.
Conclusions:
- Diabetes and associated metabolic and lifestyle factors are critical determinants of CHD in American Indians.
- Public health strategies targeting diabetes and other modifiable risk factors are essential for CHD prevention in this population.
- Geographic variations in risk factor prevalence may influence CHD outcomes.
Abstract:
Coronary heart disease (CHD) is the leading cause of death among American Indians. However, information on the prevalence of CHD and its association with known risk factors is limited. The purpose of the Strong Heart Study is to quantify CHD and its risk factors among three geographically diverse groups of American Indians. The population consists of 4,549 adults between 45 and 74 years of age in 13 Indian communities in Arizona, Oklahoma, and South and North Dakota. The phase I examination (1989-1991) revealed very high prevalence rates of diabetes that ranged from 33 to 72% in men and women in the three centers. Prevalence rates of definite myocardial infarction (MI) and definite CHD were higher in men than in women in all three centers (P < 0.0001) and in those with diabetes (P = 0.002 and P = 0.0003 in women and men respectively). Diabetes was associated with a relatively greater increase in prevalence of MI (prevalence rate = 3.8 vs. 1.9) and CHD (prevalence rate = 4.6 vs. 1.8) in women than in men. Logistic regression analysis indicated that the prevalence of CHD among American Indians was significantly related to age, diabetes, hypertension, albuminuria, percentage of body fat, smoking, high concentrations of plasma insulin, and low concentrations of HDL cholesterol. Lower prevalence rates of CHD were found in Arizona despite higher rates of diabetes, obesity, hypertension, and albuminuria; these lower rates may be in part related to lower smoking frequency and lower concentrations of total and LDL cholesterol. These findings from the baseline Strong Heart Study examination emphasize the relative importance of diabetes and its associated variables as risk factors for CHD among American Indian populations.