The State of Affairs for Cardiovascular Health Research in Indigenous Women in Canada: A Scoping Review

Abstract

Cardiovascular disease (CVD) is the leading cause of death among Indigenous peoples in Canada. As rates of CVD rise, the impacts among the growing population of Indigenous women will emerge as an important health issue. The objective of this scoping review was to advance the state of knowledge about cardiovascular health research in Indigenous women in Canada. Five databases and grey literature (non-peer reviewed works) were searched to identify all studies that reported on the prevalence, pathophysiology, diagnosis, treatment, or interventions for CVD among adult Indigenous women in Canada, including First Nations, Métis, and Inuit. Searching identified 3194 potential articles; 61 of which were included. The most commonly researched topics were the prevalence of CVD, hypertension, and dyslipidemia. Rates of CVD and associated mortality among Indigenous women appear to have surpassed those of their nonindigenous counterparts. Very little research has examined the pathophysiology, diagnosis, and treatment of CVD. Gaps in the research identified the need for sex-based analyses, comparison with nonindigenous women, comprehensive longitudinal data, assessment of diagnosis criteria, development and evaluation of cardiovascular health interventions, and a better understanding of the role of culture and traditions in the prevention and treatment of CVD among Indigenous women. Although comprehensive CVD data are lacking, rates of CVD among Indigenous women in Canada are rising and are nearing or surpassing those of nonindigenous women. This review serves as a call to action to seek further research on the pathophysiology, diagnosis, and treatment of CVD among Indigenous women from across Canada.

Listening to First Nations women’ expressions of heart health: mite achimowin digital storytelling study

“…Globally, health disparities and service inequities specific to heart health are reported among Indigenous populations [5,[16][17][18]. In Canada, while general population rates are declining, the rates of coronary artery disease have increased among Indigenous populations [1,2,19,20].…”

Sex as a Key Variable in Predicting Cardiovascular Outcomes: Rapidly Evolving Knowledge but Much More Needed

“…12 This is likely to be particularly true of groups with combined vulnerabilities, such as indigenous women, whose rate of CVD is growing significantly, and gender-related characteristics such as poverty. 13…”

Results of a culturally relevant, physical activity-based wellness program for urban Indigenous women in Alberta, Canada

“…Calls to Action numbers 88 and 89 emphasize the need to reduce barriers to Indigenous participation in physical activity and sport, and to create inclusive and culturally relevant physical activity policies, programs, and initiatives. Such participation is important given higher rates of obesity and associated diabetes and cardiovascular disease within Indigenous communities (Anand et al, 2001; Assembly of First Nations/First Nations Information Governance Committee, 2007;Diabetes Canada Clinical Practice Guidelines Expert Committee et al, 2018;Heart Research Institute, 2017;Prince et al, 2018;Tjepkema, 2005; Public Health Agency of Canada [PHAC], 2011a; Young, Reading, Elias, & O'Neil, 2000). These diseases are increasingly recognized as being shaped by sociopolitical factors in addition to genetic predisposition, particularly nutrition, physical activity, and changed relationships to the environment.…”

“…In an Atlantic Centre of Excellence for Women 's Health's (2009) literature review of Indigenous women and obesity in Canada, the authors note that "very little research provide[s] any historical or political context" for the issue of higher rates of obesity among this diverse population (Atlantic Centre of Excellence for Women's Health [ACEWH], 2009). Defined as a body mass index (BMI) of >30kg/m2, the prevalence of obesity among Indigenous women is higher (24.5% Metis-41.1% First Nations on-reserve) than in the Canadian female adult population (23.4%), a pattern repeated for Type 2 diabetes and cardiovascular disease (Anand et al, 2001;ACEWH, 2009;Canadian Diabetes Association Clinical Practice Guidelines Expert Committee et al, 2013;Chowdhury et al, 2016;Navaneelan & Janz, 2014;Oster, Mayan, & Toth, 2014;PHAC, 2011;PHAC, 2011b;Prince et al, 2018;Young et al, 2000). While the typically associated factors of poor nutrition and low levels of physical activity are often framed as "lifestyle choices" by government agencies and health professionals, such factors must be contextualized.…”