Top Things to Know: The Status of Maternal CV Health in American Indian and Alaska Native Individuals

Published: May 31, 2023

Prepared by Anne Leonard MPH, RN National Senior Director Science and Medicine

  1. Cardiovascular disease (CVD) is a leading cause of death in the American Indian and Alaska Native populations. CVD rates are higher than 12% compared to other race/ethnic groups and are likely to be underreported in this population by about 21%. CVD rates are high in younger AI/AN pregnancy-capable women. AI/AN individuals are 50% more likely to be diagnosed with premature CVD than their White counterparts.
  2. CVD is the second leading cause of death among AI/AN women, the first being cancer and life expectancy of AI/AN individuals declined by an unprecedented 6.6 years between 2019 and 2021, partly due to the COVID 19 pandemic.
  3. Research on mental, physical, behavioral, or social risk for CVD among the AI/AN population in the reproductive age is scarce. Using a culturally appropriate theoretical framework is important in this population.
  4. The American Heart Association recently identified the control of risk factors and community-based interventions that address social determinants of health (SDOH) as a way of early detection, recognition, and treatment of CVD in AI/AN individuals and outlined a multidisciplinary framework to improve maternal health in the United States.
  5. AI/AN women have the second highest pregnancy-related mortality ratio according to Pregnancy Mortality Surveillance System (PMSS) data (2007–2016) provided by the Centers for Disease Control and Prevention. This paper suggests that treating the pregnancy period is a window of opportunity for CVH promotion in AI/AN women.
  6. Determinants of cardiovascular health (CVH) in AI/AN birthing individuals are discussed in terms of the social determinants of maternal health with an emphasis on how the American Heart Association’s Life’s Essential 8 health factors and behaviors can be applied to CVD prevention for those 2 years of age and older.
    1. Hypertension (HTN) is common in AI/AN women, particularly those with T2DM and obesity.
    2. Dyslipidemia in AI/AN women with T2DM display typical diabetic dyslipidemia with high triglycerides (TG), and low high-density lipoprotein-cholesterol (HDL-C) and have increased risk of CVD and stroke.
    3. Diabetes Mellitus Type 2 (T2DM) is the predominant CVD risk factor in AI/AN women, with a prevalence of 72% in some communities.
    4. Obesity affects almost half of AI/AN women, the pathologic beginnings of which start early in life.
    5. In addition to limited physical activity, unhealthy diet has contributed to a significant increase in obesity, diabetes, and subsequent CVD in AI/AN women.
    6. Augmenting physical activity is a cornerstone of CVD prevention programs in AI/AN women.
    7. AI/AN adults report greater cigarette smoking compared to other races; approximately one-third of AI/AN women smoke.
    8. Sleep: Obstructive sleep apnea is also more prevalent in AI/AN women, due to the high prevalence of obesity, which is subsequently associated with atrial fibrillation, stroke, CVD, sudden death, arterial HTN, pulmonary HTN, right heart dysfunction and heart failure.
  7. The impact of substance use, adverse mental health conditions, lifestyle and CVD risk factors and the effects of institutional structural racism and historical traumas on AI and AN women are discussed in this statement.
  8. Social determinants related to AI/AN maternal health including psychological health, socioeconomic conditions, living and working conditions, age, sex and constitutional factors, historical trauma, and community partnerships are discussed.
  9. In addition, more than 84% of AI/AN women have experienced some for of violence, including sexual and physical (domestic) violence. Homicide rates in AI/AN women are ten times the national average in other countries and homicide rates are 2.8 times that of white women.
  10. This paper emphasizes six strategies that may lead to improvement in maternal mortality and lowering the risk of CVD in AI/AN women, and. calls for key stakeholders in government, public health, health care systems, and public policy to narrow the disparities.

View the summary for Status of Maternal Cardiovascular Health in American Indian and Alaska Native Individuals

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Citation

Sharma G, Kelliher A, Deen J, Parker T, Hagerty T, Choi EE, DeFilippis EM, Harn K, Dempsey RJ, Lloyd-Jones DM; on behalf of the American Heart Association Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology; Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and Council on Quality of Care and Outcomes Research. Status of maternal cardiovascular health in American Indian and Alaska Native individuals: a scientific statement from the American Heart Association [published online May 31, 2023]. Circ Cardiovasc Qual Outcomes. doi: 10.1161/HCQ.0000000000000117

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