Native American Heart Disease

Native American Heart Disease

  • Rates of CVD (cardiovascular disease) and its risk factors seem to be increasing in American Indian populations.
  • People with diabetes are at an increased risk of CVD and Native American groups in Arizona, Oklahoma, and North/South Dakota have been identified to have among the highest prevalences of diabetes.1
  • The California Health Interview Survey (2005) has confirmed the highest prevalence of diabetes in Native Americans (15%) compared to 10% in African Americans, 8% in Hispanics, 7% in Asians, and 6% in Caucasians.1
  • When adjusted for age, gender, other risk factors, and lifestyle characteristics, Native Americans still had the highest likelihood of diabetes (3-fold) when compared to Whites.  Among adults with diabetes, Native Americans had the highest prevalence of high cholesterol (42%).1
  • The prevalence of obesity is highest among American Indian and Alaska Native (AI/AN) adults and is increasing rapidly, especially in those with diabetes. The mean BMI increased from 32 to 34 between 1995 and 2004.
  • The American Indians with diabetes have the highest prevalence of obesity (60%) with 20% of them having class I (30.0-34.9 kg/m2), and another 20% class II (35.0-39.9 kg/m2). A surprisingly high 20% of them also have class III (>40.0 kg/m2). The increase in extreme obesity could potentially affect the burden of morbidity and mortality among this population with diabetes. Effective and culturally appropriate weight management interventions are needed.2

  • American Indians also have high prevalence of smoking, high blood pressure and low socioeconomic status. Yet the age standardized CAD mortality among American Indians is less than half that of whites and blacks (See Figure 008).3
  • Low levels of LDL and lowest level of lipoprotein (a) provides a potential explanation for the American Indian paradox.4-6
  • The Framingham scores overestimated the risk for CAD (coronary artery disease) in Native American as well as Japanese and Hispanic populations.7


1. Harjo TC, Perez A, Lopez V, Wong ND. Prevalence of diabetes and cardiovascular risk factors among California Native American adults compared to other ethnicities: the 2005 California Health Interview Survey. Metab Syndr Relat Disord. Feb 2011;9(1):49-54.

2. Wilson C, Gilliland S, Moore K, Acton K. The epidemic of extreme obesity among American Indian and Alaska Native adults with diabetes. Prev Chronic Dis. Jan 2007;4(1):A06.

3. Xu J, Kochanek K D, Murphy S L. Deaths: Final Data for 2007.National Vital Statistics Statistics Report. Vol 58,. CDC, Atlanta 2010.

4. Bhatnagar D, Morgan J, Siddiq S, Mackness MI, Miller JP, Durrington PN. Outcome of case finding among relatives of patients with known heterozygous familial hypercholesterolaemia. Bmj. Dec 16 2000;321(7275):1497-1500.

5. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic  USA; 2011.

6. Wang W, Hu D, Lee ET, et al. Lipoprotein(a) in American Indians is Low and Not Independently Associated with Cardiovascular Disease. The Strong Heart Study. Ann Epidemiol. 2002;12(2):107-114.

7. Kent DM, Griffith J. The Framingham scores overestimated the risk for coronary heart disease in Japanese, Hispanic, and Native American cohorts. ACP J Club. Jan-Feb 2002;136(1):36.

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