American Indians, Alaskan Natives carry higher heart disease burden

American Indian and Alaska Native Medicare beneficiaries carry a higher burden of cardiovascular disease -- with nearly 50% of them diagnosed with it, researchers have found.

"The American Indian and Alaska Native population has experienced significant health disparities compared with other racial and ethnic groups in the U.S.," wrote a team led by Lauren Eberly, MD, of Gallup Indian Medical Center in New Mexico. "Pervasive structural racism, broken treaty obligations, settler colonialism, genocide, and exclusionary governmental policies have concentrated poverty and fueled health inequities among Indigenous populations … [and] given this, American Indian and Alaska Native persons have a disproportionate burden of chronic disease, with the lowest life expectancy of all racial groups in the U.S."

Cardiovascular disease is diagnosed and tracked via imaging modalities such as x-ray, ultrasound, and CT and MRI scans, and unfortunately, health disparities exist in preventive care across racial groups, the team noted. Yet data regarding the incidence and prevalence of cardiovascular disease, comorbid condition burden, and risk factors are limited, Eberly and colleagues wrote.

To rectify this knowledge gap, the researchers conducted a study that included data from 220,598 American Indian and Alaska Native Medicare beneficiaries (age 65 and older) from between January 2015 and December 2019. They tracked annual incidence, prevalence, and mortality associated with coronary artery disease, heart failure, atrial fibrillation, and stroke or transient ischemic attack. Of the total beneficiary cohort, 39% came from economically distressed communities, and 44.8% had diabetes, 61.3% had high cholesterol, and 72.2% had high blood pressure.

The researchers found that the incidence of heart attack and heart failure increased over the study time frame:

Incidence of heart attack and failure among Native American and Alaska Native people, 2015-2019
Type of heart condition 2015 2019 Percentage change
Incidence of acute myocardial infarction 6.9 per 1,000 person years 7.7 per 1,000 person years 4.8%
Incidence of heart failure 26.1 per 1,000 person years 27.0 per 1,000 person years 4.1%

Although the prevalence of heart failure and atrial fibrillation remained stable during the study period, 50% of patients had at least one cardiovascular condition (coronary artery disease, heart failure, atrial fibrillation, or stroke), and the overall mortality rate was almost 20%.

The findings underscore the "critical need for future efforts to prioritize the cardiovascular health of this population," Eberly and colleagues noted.

"The path forward requires engagement to support community-led initiatives and targeted investment in Indigenous communities to rectify historical harms and address sociopolitical determinants of cardiovascular health," they concluded.

The complete study can be found here.          

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