, Volume 41, Issue 3, pp 351–361 | Cite as

Telomere length and cancer mortality in American Indians: the Strong Heart Study

  • Pooja Subedi
  • Stefano Nembrini
  • Qiang An
  • Yun Zhu
  • Hao Peng
  • Fawn Yeh
  • Shelley A. Cole
  • Dorothy A. Rhoades
  • Elisa T. Lee
  • Jinying ZhaoEmail author
Original Article


The objective of this study was to investigate whether leukocyte telomere length (LTL) predicts the risk for cancer mortality among American Indians participating in the Strong Heart Study (1989–1991). Participants (aged 45–74 years) were followed annually until December 2015 to collect information on morbidity/mortality. LTL was measured by qPCR using genomic DNA isolated from peripheral blood. The association between LTL and risk for cancer mortality was examined using a multivariable Cox proportional hazard model, adjusting for age, gender, education, study site, smoking, alcohol use, physical activity, systolic blood pressure, fasting blood glucose, obesity, and low- and high-density lipoprotein. Of 1945 participants (mean age 56.10 ± 8.17 at baseline, 57% women) followed for an average 20.5 years, 220 died of cancer. Results showed that longer LTL at baseline significantly predicts an increased risk of cancer death among females (HR 1.57, 95% CI 1.08–2.30), but not males (HR 0.74, 95% CI 0.49–1.12) (p for interaction 0.009). Specifically, compared with the women with the longest LTL (fourth quartile), those in the third, second, and first quartiles showed 53%, 41%, and 44% reduced risk for cancer death, respectively. The findings highlight the importance of sex-specific analysis in future telomere research.


Telomere length Biological aging Cancer mortality American Indians Strong Heart Study 



We thank all participants of Strong Heart Study (SHS), the Indian Health Service facilities, and participating tribal communities for their extraordinary cooperation and involvement, which has contributed to the success of SHS.


This study was supported by the National Institutes of Health–funded grants R01DK091369, U01HL65520, U01HL41642, U01HL41652, U01HL41654, and U01HL65521.

Compliance with ethical standards

Ethical approval

All procedures performed in this study were in accordance with ethical standards of Indian Health Service Institutional Review Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© American Aging Association 2019

Authors and Affiliations

  • Pooja Subedi
    • 1
  • Stefano Nembrini
    • 1
  • Qiang An
    • 2
  • Yun Zhu
    • 1
  • Hao Peng
    • 1
    • 3
  • Fawn Yeh
    • 4
  • Shelley A. Cole
    • 5
  • Dorothy A. Rhoades
    • 6
  • Elisa T. Lee
    • 4
  • Jinying Zhao
    • 1
    Email author
  1. 1.Department of Epidemiology, College of Public Health and Health Professions, College of MedicineUniversity of FloridaGainesvilleUSA
  2. 2.Department of Orthopaedics and Rehabilitation, University of Iowa Health CareUniversity of Iowa Hospitals and ClinicsIowa CityUSA
  3. 3.Department of Epidemiology, School of Public HealthMedical College of Soochow UniversitySuzhouChina
  4. 4.College of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  5. 5.Texas Biomedical Research InstituteSan AntonioUSA
  6. 6.Stephenson Cancer CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA

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