Cardiovascular Disease in American Indian and Alaska Native Youth: Unique Risk Factors and Areas of Scholarly Need
Year: 2017
Type: article
Abstract: the National Heart, Lung, and Blood Institute convened a scientific forum with 18 investigators active in the field of population health disparities.The purpose was to discuss heart, lung, and sleep disorders in children and adolescents of American Indian/Alaska Native (AI/AN) heritage.All participants acknowledged the paucity of age-and population-specific data on these disorders and called for new research to remedy the gap.As participants in that forum and seasoned investigators in the field, we summarize the current state of research on cardiovascular disease (CVD) in AI/AN youth from our unique perspective.We review the available evidence on environmental exposures, diet, physical activity, and early-onset obesity in AI/ANs, with a focus on data from individuals younger than 21 years as available, against the background of a rapidly increasing prevalence of CVD and its risk factors.It should be mentioned that the available evidence is sparse, with much of what is known about CVD in Native communities coming from the SHS (Strong Heart Study), a longitudinal, population-based study of the epidemiology of CVD and its risk factors in adult AIs from communities in Oklahoma, Arizona, North Dakota, and South Dakota.From 1989 to 1991, SHS recruited a cohort of adults aged 45 to 75 years and followed them for several waves of data collection. 1 An ancillary project, the SHFS (Strong Heart Family Study), recruited participants aged 14 years and older who belonged to the families of SHS cohort members. 2 Both SHS and SHFS collected detailed information on cardiovascular events, risk factors for CVD (including genetic and environmental factors), and markers of preclinical CVD.Our review is intended to elucidate viable avenues for future research in this neglected area. CVD Risk Factors and Subclinical CVD in AI YouthCVD was once considered rare in AIs, but lifestyle and dietary changes have contributed to a substantial increase in recent decades.3,4 As would be expected, the population prevalence of established CVD risk factors, including obesity and diabetes mellitus, has also increased relative to the US general population.5 Despite advances in raising community awareness of CVD risk factors among AIs, the prevalence of dyslipidemia, smoking, and high blood pressure is also rising.6,7 CVD is more likely to be fatal in AIs relative to other races, with mortality rates 20% higher than in the general population, 3 while age at death because of CVD is significantly lower among Native people.Fully 36% of AIs with CVD die before age 65, versus 15% of non-Hispanic whites.8 This premature morbidity and mortality among AI/AN adults likely reflects the high prevalence of CVD risk factors in Native youth.Compared with other races, AI youth are disproportionally affected by obesity, which tends to begin earlier in life, as shown by data on weight from birth to preschool age.9 One
Institutions: Seattle Children's Hospital, University of Washington, University of Washington Medical Center, University of Wisconsin–Madison, Montana State University, Cleveland Clinic, Johns Hopkins University, Columbia University, Weill Cornell Medicine, Washington State University Spokane, Georgetown-Howard Universities Center for Clinical and Translational Science, MedStar Health Research Institute
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
OpenAlex ID: W2765123335