An evaluation of a heart failure risk prediction tool indicates that American Indian adults experience rates of heart failure that may be 2 to 3 times higher than those found in other racial and ethnic groups. This risk prediction model highlights the impact of factors such as diabetes management and kidney health, pointing to smoking, Type 2 diabetes, hypertension, prior heart attacks, and kidney issues related to diabetes as significant contributors to increased heart failure risk in American Indian adults. Researchers emphasize the urgency to create preventive health strategies tailored for American Indian communities.
Recent research published in the Journal of the American Heart Association shows that heart failure rates are 2 to 3 times higher among American Indians compared to other racial and ethnic groups like African Americans, Hispanics, or whites.
This study used a new risk assessment scale designed for American Indian adults. It identified several modifiable risk factors for heart failure over a span of 5 to 10 years, including smoking, the presence of Type 2 diabetes, kidney damage, previous heart attacks, and high blood pressure.
Lead author Irene Martinez-Morata, M.D., Ph.D., a researcher at Columbia University’s Mailman School of Public Health, stated, “Incorporating our risk prediction scale into clinical settings can enhance risk evaluations and help formulate preventive approaches aimed at reducing heart failure cases and fatalities in American Indian populations, particularly those heavily impacted by Type 2 diabetes, which have often been overlooked in earlier research.”
Heart failure is one of the primary causes of death in individuals with Type 2 diabetes and is notably more prevalent in American Indian communities compared to Black, Hispanic, and white populations in the United States. Martinez-Morata pointed out that existing heart failure risk assessment tools may not accurately reflect the risk in American Indian groups and others with high rates of Type 2 diabetes.
In this study, researchers created a scale to specifically assess heart failure risk in American Indians, drawing on data from approximately 3,000 participants of the Strong Heart Study—the largest ongoing federally supported examination of heart disease in American Indian adults. This cost-effective prediction model utilizes commonly available resources to monitor Type 2 diabetes and kidney health.
Key findings from the analysis included:
- Participants of the Strong Heart Study exhibited a heart failure rate 2 to 3 times greater than those in other population-focused studies.
- Consistently high blood sugar levels were linked to a 23% increase in heart failure risk even in those diagnosed with diabetes, underscoring the critical importance of blood sugar management.
- Smoking was associated with twice the risk of developing heart failure over both 5 and 10 years.
- Elevated urine albumin, an indicator of kidney damage due to Type 2 diabetes and hypertension, corresponded to an 8-fold increase in heart failure risk over 5 years.
- Having a prior heart attack raised the risk of developing heart failure nearly 7 times within 5 years.
- Older age was linked to a 70% to 80% increase in heart failure risk over the next 5 to 10 years.
- Type 2 diabetes was found to correlate with a 74% heightened risk of heart failure within 10 years.
- High blood pressure contributed a 43% increase in the risk of developing heart failure over a period of 10 years.
The increased heart failure risk associated with Type 2 diabetes was observed to occur regardless of other common risk factors, including smoking habits, cholesterol levels, body mass index, history of heart attacks, and kidney complications.
Martinez-Morata noted that various elements contribute to Type 2 diabetes development, including lifestyle factors like poor diet and inactivity as well as exposure to environmental pollutants such as lead and arsenic.
“American Indian communities have historically faced significant injustices, including exposure to harmful substances, barriers to healthcare, and other complex social issues, leading to enduring health disparities. Consequently, the high rates of Type 2 diabetes in these populations arise from a multitude of interconnected factors, not just individual choices,” she elaborated. She also pointed out that American Indians have been underrepresented in epidemiological studies, leading to a lack of awareness about disease prevalence.
A 2020 statement from the American Heart Association highlighted that cardiovascular disease rates have been climbing among American Indians and Alaska Natives over the last 50 years. It mentioned that the social determinants of health affecting both groups are intricate and longstanding, often coupled with restricted healthcare access. Historical injustices such as land displacement, war, epidemic diseases, unfulfilled treaties, unethical research, and land loss have bred distrust in the U.S. government and the scientific community among many American Indians. Additionally, the displacement and rural living conditions, alongside limited healthcare access, exacerbate health issues. Approximately 21% of American Indians were reported to live below the federal poverty level in 2017.
Limitations of the study include incomplete data on different types of heart failure and a lack of comprehensive information regarding participants’ heart attack histories. However, the research benefited from over two decades of follow-up data on the participants.
Details about the study:
- The research analyzed data from 3,059 participants in the Strong Heart Study, with around 58% being women. The participants were aged between 45 and 74 when recruited from 13 different American Indian tribes located in North Dakota, South Dakota (Northern Plains), Oklahoma (Southern Plains), and Arizona (Southwest).
- Initial visits occurred between July 1989 and January 1992, with follow-up concluding at the end of 2019.
- 70% of the participants indicated they were current or former smokers. Clinical evaluations found that 38.7% had elevated blood sugar (as indicated by HbA1c levels), 36.7% had hypertension, and 15.2% had Type 2 diabetes.
- Approximately 16.5% of participants developed heart failure during the study period.
The manuscript includes the research team’s co-authors, potential conflicts of interest, and funding sources.
