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(Circulation. 1999;99:2389-2395.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Rising Tide of Cardiovascular Disease in American Indians
The Strong Heart Study
From Medlantic Research Institute and Washington Hospital Center, Washington, DC (B.V.H., W.J.H., D.C.R., M.L.S.); Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City (E.T.L., O.T.G.); the Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City (L.D.C.); Cornell University, College of Medicine, Ithaca, NY (R.B.D.); Center for Native American Health, Tucson, Ariz (J.M.G.); College of Medicine, University of Oklahoma, Oklahoma City (E.R.R); and Aberdeen Area Tribal Chairmen's Health Board, Rapid City, SD (T.K.W.).
Correspondence to Barbara V. Howard, PhD, Medlantic Research Institute, 108 Irving St, NW, Washington, DC 20010. E-mail bvh1{at}mhg.edu
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.
Key Words: cardiovascular diseases • heart disease • mortality • Indians, North American • risk factors
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