The incidence rate of heart failure was 2- to 3-fold higher among American Indian populations than rates observed in studies focused on other population groups, such as African American, Hispanic or white adults, in a new study published today in the . The results were calculated using a new proposed risk prediction scale for specifically for American Indian adults. The analysis also found that smoking, type 2 status, kidney damage, previous heart attack and high blood pressure are major modifiable determinants of developing heart failure over 5 to 10 years among American Indian adults.
"Implementation of our proposed risk prediction scale in clinical practice can contribute to optimized and to the development of preventive strategies to reduce heart failure events and deaths in American Indian communities and populations with a high burden of type 2 diabetes, which have been underrepresented in previous studies," said lead study author Irene Martinez-Morata M.D., Ph.
D., and a researcher at Columbia University's Mailman School of Public Health in New York City. Heart failure is a leading cause of death among people with type 2 diabetes, and occurs at a higher rate in American Indian populations than in Black, Hispanic and white populations in the U.
S. Existing heart failure risk prediction scales may not appropriately estimate the risk of heart failure among American Indian communities and other populations affected by a high rate of type 2 diabetes, Martinez-Morata noted. In this study, researchers developed a scale to predict heart failure risk specifically in American Indian people, based on data from about 3,000 participants in the Strong Heart Study, an ongoing study that is the largest to examine in American Indian adults.
The inexpensive risk prediction equation, which uses readily available tools focused on type 2 diabetes management and kidney damage. The analysis found: The elevated risk of heart failure associated with type 2 diabetes was independent of other for heart failure, including smoking, high cholesterol, body mass index, previous heart attack history and kidney complications. Martinez-Morata said multiple factors contribute to the development of type 2 diabetes, including lifestyle elements, such as an unhealthy diet and lack of physical activity, as well as exposure to environmental toxins like arsenic or lead.
"American Indian communities have suffered historical injustices in exposure to contaminants, health care accessibility and other sociodemographic factors resulting in a long history of health disparities. Thus, the documented high rates of type 2 diabetes in these communities are underlined by multiple complex factors beyond individual behaviors," she explained. "In addition, American Indian communities have been historically underrepresented in epidemiological research, resulting in underreporting of disease burden.
" A from the American Heart Association noted that the prevalence of cardiovascular disease has been rising among American Indians and Alaska Natives over the past 50 years. It stated that the facing both communities are longstanding and complex, and access to health care is limited. Historical events such as displacement, war, infectious disease, unfulfilled agreements, unethical research practices and decimation of tribal lands resulted in mistrust of the U.
S. government and the scientific and medical community for many American Indians and Alaska Natives. Being forced to move from their native lands and living in rural areas without access to proper health care contributed to the issue.
Based on 2017 data, 21% of American Indians live below the federal poverty line. The study's limitations include incomplete information about different heart failure subtypes, as well as limited data on participants' history of heart attack. The study's strengths included follow-up data for participants for more than two decades, the researchers noted.
Study details and background: Heart Failure Risk Prediction in a Population With a High Burden of Diabetes: Evidence From the Strong Heart Study, (2024)..
