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The epidemiology of atherosclerosis and its risk factors among Native Americans

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Abstract

In the past, the rates of risk factors for atherosclerosis and cardiovascular disease (CVD) as well as the manifestations of coronary heart disease, stroke, and peripheral vascular disease in Native Americans have been relatively low compared to the general United States population. However, over the past several decades the rates of these CVD-associated risk factors have markedly increased with the concomitant development of a significant and alarming rise in the manifestations of atherosclerosis.

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References and Recommended Reading

  1. Harwell TS, Gohdes D, Moore K, et al.: Cardiovascular disease and risk factors in Montana American Indians and non-Indians. Am J Prev Med 2001, 20:196–201. An interesting comparison of the prevalence of CVD and its risk factors in American Indians and non-Indians from the same geographical area using the 1999 Behavioral Risk Factor Surveillance Survey.

    Article  PubMed  CAS  Google Scholar 

  2. Sytkowski PA, Kannel WB, D'Agostino RB: Changes in risk factors and the decline in mortality from cardiovascular disease. The Framingham Heart Study. N Engl J Med 1990, 322:1635–1641.

    Article  PubMed  CAS  Google Scholar 

  3. Gilbert TJ, Percy CA, Sugarman JR, et al.: Obesity among Navajo adolescents: relationship to dietary intake and blood pressure. Am J Dis Child 1992, 146:289–295.

    PubMed  CAS  Google Scholar 

  4. Salsbury CG: Disease incidence among the Navajos. Southwest Med 1937, 21:230–233.

    Google Scholar 

  5. Kunitz S: Disease Change and the Role of Medicine: The Navajo Experience. Berkeley, CA: University of California Press; 1983.

    Google Scholar 

  6. Sugarman JR, Hickey M, Hall T, Gohdes DM: The changing epidemiology of diabetes among Navajo Indians. West J Med 1990, 153:140–145.

    PubMed  CAS  Google Scholar 

  7. Sugarman J, Percy C: Prevalence of diabetes in a Navajo Indian Community. Am J Public Health 1989, 79:511–513.

    PubMed  CAS  Google Scholar 

  8. Prosnitz LR, Mandell GC: Diabetes mellitus among Navajo and Hopi Indians: the lack of vascular complications. Am J Med Sci. 1967, 253:700–705.

    Article  PubMed  CAS  Google Scholar 

  9. Rate RG, Knowler WC, Morse HG, et al.: Diabetes mellitus in Hopi and Navajo Indians: prevalence of microvascular complications. Diabetes 1983, 32:894–899.

    Article  PubMed  CAS  Google Scholar 

  10. Centers for Disease Control and Prevention: Intertribal Heart Project: Results from the Cardiovascular Health Survey. Atlanta, GA: Centers for Disease Control and Prevention; 1996.

    Google Scholar 

  11. Lee ET, Howard BV, Savage PJ, et al.: Diabetes and impaired glucose tolerance in three American Indian populations aged 45-74 years. The Strong Heart Study. Diabetes Care 1995, 18:599–610.

    Article  PubMed  CAS  Google Scholar 

  12. Harris MI: Impaired glucose tolerance in the U.S. population. Diabetes Care 1989, 12:464–474.

    Article  PubMed  CAS  Google Scholar 

  13. Welty TK, Rhoades DA, Yeh F, et al.: Changes in cardiovascular risk factors among American Indians: the Strong Heart Study. Ann Epidemiol 2002, 12:97–106. An excellent longitudinal review of the changes in CVD risk factors among Native Americans in the SHS over time.

    Article  PubMed  Google Scholar 

  14. National Center for Health Statistics: Healthy People 2000 Review, 1995–1996. Hyattsville, MD: Public Health Service; 1996.

    Google Scholar 

  15. Kannel WB, McGee DL: Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham Study. Diabetes Care 1979, 2:120–126.

    Article  PubMed  CAS  Google Scholar 

  16. Howard BV, Lee ET, Cowan LD, et al.: Coronary heart disease prevalence and its relation to risk factors in American Indians: the Strong Heart Study. Am J Epidemiol 1995, 142:254–268.

    PubMed  CAS  Google Scholar 

  17. Howard BV: Macrovascular complications of diabetes mellitus. In Diabetes Mellitus. Edited by LeRoith D, et al. Philadelphia, PA: Lippincott-Raven; 1996:792–797.

    Google Scholar 

  18. Stern MP: Do non-insulin dependent diabetes mellitus and cardiovascular disease share common antecedents? Ann Intern Med 1996, 124:110–116.

    PubMed  CAS  Google Scholar 

  19. Hayden J, Reaven PD: Cardiovascular disease in diabetes mellitus type 2: a potential role for novel cardiovascular risk factors. Curr Opin Lipidol 2000, 11:519–528.

    Article  PubMed  CAS  Google Scholar 

  20. Harris MI: Summary. In Diabetes in America, edn 2. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; NIH Pub. No. 95-1468. 1995.

    Google Scholar 

  21. Howard BV, Robbins DC, Sievers ML, et al.: LDL cholesterol as a strong predictor of coronary heart disease in diabetic individuals with insulin resistance and low LDL: the Strong Heart Study. Arterioscler Thromb Vasc Biol 2000, 20:830–835.

    PubMed  CAS  Google Scholar 

  22. Howard BV, Lee ET, Cowan LD, et al.: Rising tide of cardiovascular disease in American Indians: the Strong Heart Study. Circulation 1999, 99:2389–2395. A good review of the more recent and concerning data related to CVD and its risk factors among Native Americans.

    PubMed  CAS  Google Scholar 

  23. Fulmer HS, Roberts RW: Coronary heart disease among the Navajo Indians. Ann Intern Med 1963, 59:740–764.

    PubMed  CAS  Google Scholar 

  24. Strotz CR, Shorr GI: Hypertension in Papago Indians. Circulation 1973, 48:1299–1303.

    PubMed  CAS  Google Scholar 

  25. DeStefano F, Coulehan J, Wiant MK: Blood pressure survey on the Navajo Indian reservation. Am J Epidemiol 1979, 109:335–345.

    PubMed  CAS  Google Scholar 

  26. Alfred BM: Blood pressure changes among male Navajo migrants to an urban environment. Can Rev Sociol Anthropol 1970, 7:189–200.

    Article  Google Scholar 

  27. Young TK: Prevalence and correlates of hypertension in a subarctic Indian population. Prev Med 1991, 20:474–485.

    Article  PubMed  CAS  Google Scholar 

  28. Howard BV: Blood pressure in 13 American Indian communities: the Strong Heart Study. Public Health Rep 1996, 3(suppl 2):47–48.

    Google Scholar 

  29. Modan M, Halkin H, Almong S, et al.: Hyperinsulinemia: a link between hypertension, obesity and glucose intolerance. J Clin Invest 1985, 75:809–817.

    Article  PubMed  CAS  Google Scholar 

  30. Jarrett RJ, Keen H, McCartney M, et al.: Glucose tolerance and blood pressure in two population samples: their relation to diabetes mellitus and hypertension. Int J Epidemiol 1978, 7:15–24.

    Article  PubMed  CAS  Google Scholar 

  31. Saad MF, Knowler WC, Pettitt DJ, et al.: Insulin and hypertension: relationship to obesity and glucose intolerance in Pima Indians. Diabetes 1990, 39:1430–1435.

    Article  PubMed  CAS  Google Scholar 

  32. Howard BV, Lee ET, Yeh JL, et al.: Hypertension in adult American Indians: the Strong Heart Study. Hypertension 1996, 28:256–264.

    PubMed  CAS  Google Scholar 

  33. Franklin SS, Gustin WI, Wong ND, et al.: Hemodynamic patterns of age-related changes in blood pressure: the Framingham Heart Study. Circulation 1997, 96:308–315.

    PubMed  CAS  Google Scholar 

  34. Lee ET, Lee VS, Lu M, et al.: Incidence of renal failure in NIDDM: the Oklahoma Indian Diabetes Study. Diabetes 1994, 43:572–579.

    Article  PubMed  CAS  Google Scholar 

  35. Nelson RG, Pettett DJ, Carraher MJ, et al.: Effect of proteinuria on mortality in NIDDM. Diabetes 1988, 37:1499–1504.

    Article  PubMed  CAS  Google Scholar 

  36. Dawber TR: The Framingham Study: The Epidemiology of Atherosclerotic Disease. Cambridge, MA: Harvard University Press; 1980.

    Google Scholar 

  37. Coulehan JL, Lerner G, Helzlsouer K, et al.: Acute myocardial infarction among Navajo Indians, 1976–1983. Am J Public Health 1986, 76:412–414.

    PubMed  CAS  Google Scholar 

  38. Diabetes Audit. Hyattsville, MD: Indian Health Service, US Public Health Service; 1998.

  39. Mendlein JM, Freedman DS, Peter D, et al.: Risk factors for coronary heart disease among Navajo Indians: findings from the Navajo Health and Nutrition Survey. J Nutr 1997, 127:2099S-2105S.

    PubMed  CAS  Google Scholar 

  40. Greenlund KJ, Valdez R, Casper ML, et al.: Prevalence and correlates of the insulin resistance syndrome among Native Americans: the Inter-Tribal Heart Project. Diabetes Care 1999, 22:441–447.

    Article  PubMed  CAS  Google Scholar 

  41. Sugarman J, Percy C: Prevalence of diabetes in a Navajo Indian Community. Am J Public Health 1989, 79:511–513.

    PubMed  CAS  Google Scholar 

  42. Rhoades ER: American Indian Health: Innovations in Health Care, Promotion and Policy. Baltimore, MD: The Johns Hopkins University Press; 2000. An excellent reference textbook that reviews many of the medical aspects of health and disease in a cultural context, with a review of some of the political and social history and future implications.

    Google Scholar 

  43. Sievers ML, Fisher JR: Diseases of North American Indians. In Biocultural Aspects of Disease. Edited by Rothschild HR. New York: Academic Press; 1981:191–252.

    Google Scholar 

  44. Clifford NJ, Kelly JJ, Leo TF, Eder HA: Coronary heart disease and hypertension in the White Mountain Apache Tribe. Circulation 1963, 28:926–931.

    PubMed  CAS  Google Scholar 

  45. Klain M, Coulehan J, Arena V, Janett R: More frequent diagnosis of acute myocardial infarction among Navajo Indians. Am J Public Health 1988, 78:1351–1352.

    Article  PubMed  CAS  Google Scholar 

  46. Indian Health Service: Trends in Indian Health, 1997. Hyattsville, MD: US Department of Health and Human Services, Public Health Service; 1997.

    Google Scholar 

  47. Chambless TA, Heiss G, Folsom AR, et al.: Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987 to 1993. Am J Epidemiol 1997, 146:483–494.

    PubMed  CAS  Google Scholar 

  48. O'Leary DH, Polak JF, Wolfson SK Jr, et al.: Use of sonography to evaluate carotid atherosclerosis in the elderly: the Cardiovascular Health Study. Stroke 1991, 22:1155–1163.

    PubMed  Google Scholar 

  49. Roman MJ, Fabsitz RR, Crawford A, et al.: Comparison of carotid atherosclerosis in American Indians and the general U.S. population [abstract]. Circulation 1998, 98(suppl):I-516.

    Google Scholar 

  50. Lee ET, Welty TK, Fabsitz R, et al.: The Strong Heart Study: a study of cardiovascular disease in American Indians: design and methods. Am J Epidemiol 1990, 132:1141–1155.

    PubMed  CAS  Google Scholar 

  51. Gillum RF: The epidemiology of stroke in Native Americans. Stroke 1995, 26:514–521.

    PubMed  CAS  Google Scholar 

  52. Welty TK, Coulehan JL: Cardiovascular disease among American Indians and Alaska Natives. Diabetes Care 1993, 6(suppl 1):277–283.

    Article  Google Scholar 

  53. Grove RD, Hetzel AM: Vital Statistics Rates in the United States 1940–1960. Washington, D.C.: Centers for Disease Control and Prevention, National Center for Health Statistics, Public Health Service. 1968.

    Google Scholar 

  54. Grove RD, Hetzel AM: Vital Statistics of the United States, vol 2, Mortality, Part A, for data years 1950–1993. Washington, D.C.: Public Health Service; 1993.

    Google Scholar 

  55. Indian Health Service: Indian Health Service Regional Differences in Indian Health; 1998–1999. Hyattsville, MD: US Department of Health and Human Services, Public Health Service; 1999.

    Google Scholar 

  56. Manolio TA, Kronmal RA, Burke GL, et al.: Short-term predictors of incident stroke in older adults: the Cardiovascular Health Study. Stroke 1996, 27:1479–1486.

    PubMed  CAS  Google Scholar 

  57. National Center for Health Statistics: Health, United States, 1992. Hyattsville, MD: US Public Health Service; 1993.

    Google Scholar 

  58. National Center for Health Statistics: Vital Statistics of the United States, vol 2, Mortality, Part A. Washington, D.C.: Public Health Service; 1991.

    Google Scholar 

  59. Frey JL, Jahnke HK, Bulfinch EW: Differences in stroke between white, hispanic and Native American patients. Stroke 1998, 29:29–33.

    PubMed  CAS  Google Scholar 

  60. Mustacchi P: Risk factors in stroke. West J Med 1985, 143:186–192.

    PubMed  CAS  Google Scholar 

  61. Hoy W, Light A, Megill D: Cardiovascular disease in Navajo Indians with type 2 diabetes. Public Health Rep 1995, 110:87–94.

    PubMed  CAS  Google Scholar 

  62. Hoy W, Light A, Megill D: Blood pressure in Navajo Indians and its association with type 2 diabetes and renal and cardiovascular disease. Am J Hypertens 1994, 7:321–328.

    PubMed  CAS  Google Scholar 

  63. Fabsitz RR, Sidawy AN, Go O, et al.: Prevalence of peripheral artery disease and associated risk factors in American Indians: the Strong Heart Study. Am J Epidemiol 1999, 149:330–338.

    PubMed  CAS  Google Scholar 

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  1. The Native American Cardiology Program, University of Arizona, 1501 N. Campbell Avenue, 85724, Tucson, AZ, USA

    James M. Galloway MD

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  1. James M. Galloway MD
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Galloway, J.M. The epidemiology of atherosclerosis and its risk factors among Native Americans. Curr Diab Rep 2, 274–281 (2002). https://doi.org/10.1007/s11892-002-0095-1

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