Top Things to Know: Cardiovascular Disease in American Indians and Alaskan Natives
Published: May 28, 2020
- Cardiovascular disease (CVD) is the leading cause of death in American Indians and Alaska Natives.
- Diabetes is the leading cause of heart disease in American Indians and Alaska Natives.
- American Indians and Alaska Natives are disproportionately affected by heart disease compared to other racial and ethnic groups.
- Heart disease rates are believed to be underreported by 21% among American Indians and Alaska Natives due to incorrect reporting of race and ethnicity.
- The U.S. displacement of American Indians and Alaska Natives resulted in a dependence on the U.S. government for healthcare. The Indian Health Services system remains underfunded and leaves many underinsured. In 2017, Indian Health Service per capita spending was $4,078 compared to $8,109 for Medicaid, $10,692 for Veterans Health Administration, and $13,185 for Medicare.
- Additional CVD risk factors include elevated LDL-C, hypertension, renal disease, age, and sex. Tobacco use and toxic metal exposure are also risk factors for some sub-populations of American Indian and Alaska Natives.
- Community-based interventions such as the Diabetes Prevention Program and Healthy Heart have been a key part of successful implementation of guidelines-based care among diverse patient populations.
- Research programs based in American Indian and Alaska Native populations, such as the Strong Heart Study, have made major advances in improving the cardiovascular health of the population. Key elements include community input and consent for all activities, returning study findings to the community, and including community members as investigators and leaders for the studies.
- The Special Diabetes Program for Indians is a national community-based program that has been successful in reducing heart disease risk among American Indians and Alaska Natives.
- Intervening at multiple levels of social determinants of health can help reduce risk of CVD in American Indians and Alaska Natives.
Citation
Breathett K, Sims M, Gross M, Jackson EA, Jones EJ, Navas-Acien A, Taylor H, Thomas KL, Howard BV; on behalf of the American Heart Association Council on Epidemiology and Prevention; Council on Quality of Care and Outcomes Research; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Lifestyle and Cardiometabolic Health. Cardiovascular health in American Indians and Alaska Natives: a scientific statement from the American Heart Association [published online ahead of print May 28, 2020]. Circulation. doi: 10.1161/CIR.0000000000000773.