Cardiovascular Health in American Indians and Alaska Natives: A Scientific Statement From the American Heart Association

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death among American Indians and Alaska Natives. Over the past 50 years, the prevalence of CVD has been rising among American Indians and Alaska Natives. The objective of this statement is to summarize population-level risk factors and management techniques tailored for the American Indian and Alaska Native populations. Methods: PubMed/MEDLINE, the Centers for Disease Control and Prevention, and the annual Heart Disease and Stroke Statistics report from the American Heart Association were used to identify risk factors and interventions specific to American Indians and Alaska Natives. Results: Diabetes mellitus is a major contributor to disproportionately higher rates of coronary heart disease among American Indians and Alaska Natives compared with other racial and ethnic groups. Additional risk factors for CVD include low-density lipoprotein cholesterol levels, hypertension, renal disease, age, and sex. Smoking and exposure to toxic metals are risk factors for some subpopulations. A quarter of American Indians live below the federal poverty line, and thus, low socioeconomic status is an important social determinant of cardiovascular health. Community-based interventions have reduced CVD risk in American Indians and Alaska Natives. Underreporting of American Indian and Alaska Native race could underestimate the extent of CVD in this population. Conclusions: Prevention and treatment of CVD in American Indians and Alaska Natives should focus on control of risk factors and community-based interventions that address social determinants of health, particularly among individuals with diabetes mellitus. Accurate reporting of race/ethnicity is encouraged to address race-specific risk factors.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

“…A few studies in our review reported a low prevalence of diabetes among some indigenous populations in LatAm [55,74,82], in parallel to some previous reports [283][284][285][286] about other indigenous groups in the region and in contrast with the higher prevalence of diabetes among American Indians in the USA [287] and the First Nations in Canada [288]. However, other studies in our review and in the current literature have documented elevated diabetes prevalence or risk among indigenous and other socioeconomically disadvantaged ethnic groups [48,50,73,76,77,83,90,91,166,[289][290][291][292][293].…”

Health-Related Behavioral Risk Factors and Obesity Among American Indians and Alaska Natives of the United States: Assessing Variations by Indian Health Service Region

“…The projected AI/AN population alone or in combination will reach 10.1 million in 2060 ( 8 ). AI/AN people have a higher burden of many chronic diseases including type 2 diabetes, hypertension, cardiovascular diseases, cancers, and mental illnesses ( 9 – 12 ). A national survey of the US adult population in 2014–2018 reported that, compared with all US adults, AI/AN adults had a significantly higher prevalence of having a severe disability (16.3% vs 8.9%), diagnosed hypertension (33.7% vs 28.7%), diagnosed diabetes (15.0% vs 8.6%), and multiple chronic conditions (31.9% vs 24.2%) ( 12 ).…”

Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona

“…This suggests there is a need for more detailed information in the kidney cancer databases of other risk factors, including smoking, obesity, diabetes, hypertension, and chronic kidney disease, which are known risk factors of RCC pathogenesis and potential factors that influence survival after surgical treatment [20]. We know from other cancers [21,22] and other chronic conditions [23,24] that these risks are disproportionately higher among AI/AN [25]. We also know that the cancer experiences for AI/AN individuals and families are challenging [26] and that comprehensive programs to address AI/AN cancer health disparities are needed [27][28][29].…”