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The Increasing Incidence of Coronary Artery Disease and Cardiovascular Risk Factors Among a Southwest Native American Tribe
The White Mountain Apache Heart Study
Justin L. Sewell, MPH;
Beth R. Malasky, MD;
Curtis L. Gedney, MD, PhD;
Trevor M. Gerber, BA;
Eric A. Brody, MD;
Edith A. Pacheco, RN;
David Yost, MD;
Betty R. Masden, PA-C;
James M. Galloway, MD
Arch Intern Med. 2002;162:1368-1372.
Background Rates of cardiovascular disease and its risk factors seem to be increasing
in American Indian populations, yet these changes have received little documentation.
Objectives To evaluate incidence rates of coronary artery disease, acute myocardial
infarction, and cardiac events during a 10-year period (1987-1996); to assess
cardiac risk factors for an American Indian tribe in Arizona.
Methods A retrospective medical chart review was performed for tribal members
from January 1, 1987-December 31, 1996. Patient records with even minor indications
of coronary disease were reviewed independently by 2 cardiologists of the
Native American Cardiology Program. Multiple databases were reviewed in an
effort to find all diagnoses, and incidence rates were calculated and analyzed
for increasing trends. Cardiac risk factors were assessed in a population
convenience sample.
Results From 1987 through 1996, the number of incident cases increased from
3 to 18 for coronary artery disease, 1 to 10 for acute myocardial infarction,
and 3 to 26 for cardiac events. Statistically significant increasing trends
were calculated for each. Of our youthful convenience sample, 49% had 2 or
more cardiac risk factors.
Conclusions This study confirms increasing rates of coronary artery disease and
its comorbidities in this American Indian population and demonstrates high
prevalence of cardiovascular risk factors among tribal members without extant
coronary disease. This suggests that coronary disease will likely continue
to increase as this population ages. To prevent such increases, culturally
appropriate, aggressive preventive interventions are needed.
From the Native American Cardiology Program, University of Arizona,
Tucson (Messrs Sewell and Gerber, Drs Malasky, Gedney, Brody, and Galloway,
and Ms Pacheco); Department of Clinical Medicine, Sarver Heart Center (Drs
Malasky, Brody, and Galloway), University of Arizona College of Medicine,
Tucson; Indian Health Service, Tucson (Drs Brody, Yost, and Galloway and Mss
Pacheco and Masden); and Whiteriver Public Health Service Hospital, Whiteriver,
Ariz (Dr Yost and Ms Masden).
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