Rising Tide of Cardiovascular Disease in American Indians

Abstract

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.

Mitral Ratio of Peak Early to Late Diastolic Filling Velocity as a Predictor of Mortality in Middle-Aged and Elderly Adults

“…7 Participants were classified as hypertensive if resting BP was Ն140 mm Hg systolic and/or 90 mm Hg diastolic or they took antihypertensive medications. Definite or possible coronary heart disease (CHD) was diagnosed on the basis of clinical and ECG evidence of CHD or myocardial infarction 9,10 ; participants were classified as having congestive heart failure (CHF) as previously described. 9,10 For the present analysis, participants with Ն3ϩ aortic or mitral regurgitation or heart rate Ͼ100 bpm were excluded.…”

Relationship of High and Low Ankle Brachial Index to All-Cause and Cardiovascular Disease Mortality

“…13 American Indians have high rates of both CVD and type 2 diabetes, making this a relevant population in which to compare the effects of low and high ABI on mortality risk. 14,15 We hypothesized that compared with participants with 0.90 ՅABI Յ1.40, those with both low and high ABI would have higher rates of all-cause and CVD mortality, independent of other CVD risk factors.…”

Proteinuria is a Prognostic Marker for Cardiovascular Mortality: NIPPON DATA 80, 1980-1999

“…21 Urinary albumin is related to risk factors for cardiovascular diseases, 15,22 but in only a few studies has diabetes mellitus or the history of renal diseases been assessed. 23 In addition, most of these studies have been conducted in European countries and in the United States. Studies about the relationship between proteinuria and mortality among non-whites are also limited.…”