The Combined Burden of Diabetes and Cardiovascular Disease in Indigenous Australians
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Type 2 diabetes mellitus (T2DM), cardiovascular disease, and chronic kidney disease are significant contributors to the 17-year disparity in life expectancy between Indigenous and non-Indigenous Australians. These three conditions are prevalent from a young age in Indigenous Australians and clearly contribute to their premature mortality. Risk factors that both exacerbate and promote these conditions include central obesity, dyslipidemia, cigarette smoking, albuminuria, inflammation, and poor socio-economic status. Although rates of screening for T2DM are higher in Indigenous Australians than in non-Indigenous Australians, gaps in clinical management of both T2DM and cardiovascular disease exist. To enhance survival and quality of life, prevention strategies are required at a population level and from a young age in Indigenous Australians.
KeywordsCardiovascular disease Diabetes Indigenous Australians Aboriginal Metabolic syndrome
LMB is supported by NHMRC #605837 and the Centre of Clinical Research Excellence in Clinical Science in Diabetes, University of Melbourne. The author wished to thank Professor Kerin O’Dea for comments on this manuscript.
Louise Maple-Brown reports no potential conflict of interest relevant to this article.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Australian Bureau of Statistics. Population Characteristics, Aboriginal and Torres Strait Islander Australians. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/82742A1B597A338CCA257718002A6FCE?opendocument. Accessed 22 December 2010. 2006.
- 2.Australian Commonwealth Department of Health and Aged Care. Measuring Remoteness: Accessibility/Remoteness Index of Australia (ARIA). http://www.health.gov.au/internet/main/publishing.nsf/Content/7B1A5FA525DD0D39CA25748200048131/$File/ocpanew14.pdf. Accessed 22 December 2010. 2001.
- 3.Heart, stroke and vascular disease: Australian facts 2004. Cardiovascular Disease Series, No. 22. 2004, Australian Institute of Health and Welfare and National Heart Foundation of Australia: Canberra.Google Scholar
- 14.Heart, stroke and vascular disease: Australian facts. Cardiovascular Disease Series, No. 14. 2001, Australian Institute of Health and Welfare, National Heart Foundation of Australia, National Stroke Foundation of Australia: Canberra. 2001.Google Scholar
- 16.• Bradshaw PJ, Alfonso HS, Finn JC, et al.: Coronary heart disease events in Aboriginal Australians: incidence in an urban population. Med J Aust 2009, 190(10): 583–6. This study provides important longitudinal data on coronary heart disease events in urban Indigenous Australians. PubMedGoogle Scholar
- 17.• Vos T, Barker B, Begg S, et al.: Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. Int J Epidemiol 2009, 38(2): 470–7. This study uses the burden of disease approach to identify contributors to the health gap between Indigenous and non-Indigenous Australians. The important findings are the significant impact of chronic conditions such as diabetes and cardiovascular disease, and the disproportionate burden of disease in remote (compared to urban) Indigenous Australians. PubMedCrossRefGoogle Scholar
- 18.• Brown A, Brieger D, Tonkin A, et al.: Coronary disease in indigenous populations: summary from the CSANZ indigenous Cardiovascular Health Conference. Heart Lung Circ 2010, 19(5–6): 299–305. This is an excellent summary of the background and current issues related to coronary disease in Indigenous Australians. PubMedCrossRefGoogle Scholar
- 23.Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey 2004–2005. 2006, Canberra.Google Scholar
- 30.• O’Dea K, Cunningham J, Maple-Brown L, et al. Diabetes and cardiovascular risk factors in urban Indigenous adults: results from the DRUID study. Diabetes Res Clin Pract. 2008;80(3):483–9. This study is the largest comprehensive study of urban Indigenous Australians, important as 76% of Indigenous Australians live in the urban setting but the majority of research has been conducted in regional and remote settings. The index of obesity most closely associated with diabetes in this cross-sectional study was waist-to-hip ratio. PubMedCrossRefGoogle Scholar
- 32.• O’Neal DN, Piers LS, Iser DM, et al. Australian Aboriginal people and Torres Strait Islanders have an atherogenic lipid profile that is characterised by low HDL-cholesterol level and small LDL particles. Atherosclerosis. 2008;201(2):368–77. This study describes the marked lipid abnormalities commonly seen in Indigenous Australians: dyslipidaemia including high triglycerides, low HDL and small LDL. PubMedCrossRefGoogle Scholar
- 39.• Wang Z and Hoy WE: C-reactive protein: an independent predictor of cardiovascular disease in Aboriginal Australians. Aust N Z J Public Health 2010, 34 Suppl 1: S25-9. This study higlights the important independent contribution of non-traditional CVD risk factors such as CRP to CVD cases among Indigenous Australians. PubMedCrossRefGoogle Scholar
- 50.ANZDATA Registry Report, S. McDonald, L. Excell, and B. Livingston, Editors. 2009, Australia and New Zealand Dialysis and Transplant Registry: Adelaide.Google Scholar
- 57.National Heart Foundation of Australia. Guidelines for the assessment of absolute cardiovascular disease risk 2009. Available at http://www.heartfoundation.org.au/SiteCollectionDocuments/A_AR_Guidelines_FINAL%20FOR%20WEB.pdf . Accessed January 5, 2011.
- 58.Central Australian Rural Practitioners Association. CARPA standard treatment manual. 5th ed. Alice Springs: CARPA; 2009.Google Scholar