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Risk factors for cardiovascular disease in individuals with diabetes. The Strong Heart Study
1Medlantic Research Institute, Washington, DC 20010, USA.
Insights
Coronary heart disease (CHD) is a major cause of death in people with diabetes. The Strong Heart Study found that diabetes significantly increases CHD risk, especially in American Indian populations with high diabetes rates.
Area of Science:
- Cardiovascular Epidemiology
- Diabetes Mellitus Research
- American Indian Health
Background:
- Coronary heart disease (CHD) is the primary cause of mortality in individuals with diabetes.
- Limited data exists on CHD and its risk factors in populations with high diabetes prevalence.
Purpose of the Study:
- To assess the prevalence of CHD and associated risk factors within three diverse American Indian communities.
- To investigate the relationship between diabetes and CHD in a high-prevalence population.
Main Methods:
- The Strong Heart Study enrolled 4549 American Indian adults aged 45–74 years across Arizona, Oklahoma, and the Dakotas.
- Data collection included assessment of CHD, myocardial infarction (MI), diabetes, and various cardiovascular risk factors.
- Logistic regression analysis was used to identify significant predictors of prevalent CHD.
Main Results:
- CHD and MI prevalence were higher in men than women and significantly elevated in individuals with diabetes.
- Diabetes showed a disproportionately greater association with MI and CHD prevalence in women compared to men.
- Key risk factors for CHD included age, diabetes, hypertension, albuminuria, body fat, smoking, high insulin, and low HDL-cholesterol.
Conclusions:
- Diabetes is a critical risk factor for CHD in American Indian populations with high diabetes rates.
- Diabetes-associated variables play a significant role in the development of CHD in these communities.
- Findings highlight the need for targeted cardiovascular disease prevention strategies in diabetic American Indians.
Abstract:
Coronary heart disease (CHD) is the leading cause of death among individuals with diabetes. However, information on CHD and its association with known risk factors in populations with high rates of diabetes 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 who have a high prevalence of diabetes. The study group consisted of 4549 adults between 45 and 74 years of age in 13 Indian communities in Arizona, Oklahoma, and South and North Dakota. Rates of diabetes ranged from 33% to 72% in men and women in the three centers. The 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 higher 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 (PR = 3.8 vs 1.9) and CHD (PR = 4.6 vs 1.8) in women than in men. Logistic regression analysis indicated that prevalent CHD was significantly related to age, diabetes, hypertension, albuminuria, percent body fat, smoking, high concentrations of plasma insulin, and low concentrations of high-density lipoprotein (HDL)-cholesterol. These findings from the baseline Strong Heart Study examination emphasize the relative importance of diabetes-associated variables as risk factors for CHD among populations with high rates of diabetes.