Original articleChanges in Cardiovascular Disease Risk Factors among American Indians: The Strong Heart Study
Introduction
Mortality from cardiovascular disease (CVD) in the United States has been steadily declining in recent decades, and this improvement is attributable in part to decreased prevalence of major cardiovascular risk factors (1). However, recent reports suggest that both mortality rates and incidence rates are rising among American Indians (2) Cardiovascular mortality rates among American Indians aged 45 to 74 years were as high or higher than corresponding state rates in 1984–1988 (3). Furthermore, several studies report rapid and alarming increases in the prevalence of cardiovascular risk factors among American Indian communities 4, 5, 6, 7.
To our knowledge, longitudinal trends in the prevalence of CVD risk factors in a diverse population of American Indians have never been examined. Previously, we described the prevalence of major CVD risk factors among the Strong Heart Study (SHS) cohort of American Indian adults aged 45 to 74 years (8). We now report changes in these risk factors after 4 years of follow up.
Section snippets
Study Population
The eligible population for the first SHS examination in-cluded individuals aged 45 to 74 years between 1989 and 1991 who resided in their tribal communities and were members of the following tribes: Akimel O'odham/PeePosh/Tohono O'odham of central Arizona in the Gila River, Salt River, and Ak-Chin Indian communities; the seven Tribes of southwestern Oklahoma (Apache, Caddo, Comanche, Delaware, Ft. Sill Apache, Kiowa, and Wichita); the Oglala and Cheyenne River Sioux of South Dakota, and the
Results
Baseline age, income, lipid concentrations, and prevalence rates of hypertension, smoking, alcohol use, obesity, diabetes, and proteinuria among the 3638 survivors who came to the follow-up examination were compared with those among the 496 survivors (238 men and 258 women) who did not. Only two significant differences were found: surviving women who came to the follow-up examination had lower mean total cholesterol than those who did not (5.3 mg/dl); and the prevalence of smoking was lower
Discussion
This is the largest longitudinal study to assess changes in CVD and its risk factors in a diverse group of adult American Indians. Although some changes over the 4 years of follow up represented improvements in CVD risk factors, several adverse changes occurred that will likely increase morbidity and mortality from CVD in this cohort.
Unfavorable changes in the lipoprotein profile of this population included increases in LDL cholesterol for women and decreases in HDL cholesterol for both men and
Summary
The rapid increases in the prevalence rates of the strongest CVD risk factors, especially diabetes, highlight the urgent need for community-based and clinical efforts to combat the epidemics of chronic diseases in Indian communities. Primary prevention of obesity starting in childhood by healthful eating and increased physical activity is essential because obesity is a risk factor for both CVD and diabetes (37). Physical activity is also protective against the development of diabetes and
Selected Abbreviations and Acronyms
Acknowledgements
This study was conducted by cooperative agreements U01-HL41642, U01-HL41652 and U01-HL41654 from the National Heart, Lung, and Blood Institute. The authors acknowledge the assistance and cooperation of the participating tribes and the Indian Health Service facilities that serve those tribes. The authors also thank the study participants, the Directors of SHS clinics, Betty Jarvis, Martha Stoddart, Beverly Price, Marcia O'Leary, Dr. Tauqeer Ali, Alan Crawford and their staffs, LaVonne Looking
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