Heart failure rates may be two to three times higher among American Indian populations compared to Black, Hispanic or white adults, according to a new analysis. The study, published in the Journal of the American Heart Association, used a newly proposed risk prediction tool developed specifically for American Indian people.
The analysis found that smoking, body mass index, kidney damage, and poorly controlled Type 2 diabetes were major factors in determining heart failure risk for this population. The prediction tool can better assess risk and help develop preventive strategies to reduce heart failure events and deaths among American Indians.
Heart failure occurs when the heart doesn’t pump effectively, limiting oxygen-rich blood supply to the body. It is a leading cause of death among people with Type 2 diabetes, which affects American Indians at disproportionately higher rates.
About 1 in 4 American Indian or Alaska Native adults have Type 2 diabetes, a rate three times higher than their white peers.
The risk prediction equation used in the study included measures of diabetes control and kidney damage, as Type 2 diabetes can contribute to heart failure development. Researchers analyzed data from the Strong Heart Study, the largest to examine heart disease in American Indian adults.
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Overall, 16.5% of study participants developed heart failure, a rate two to three times higher than for other racial/ethnic groups. The highest rates were found among those with Type 2 diabetes and kidney damage at enrollment.
Having Type 2 diabetes alone was linked to a 74% higher 10-year heart failure risk, while kidney damage suggested an eightfold higher 5-year risk. Poorly controlled blood sugar in those with diabetes was associated with a 23% higher heart failure risk.
Other major risk factors included smoking (double the 5- and 10-year risk), previous heart attack (nearly 7 times higher 5-year risk), and older age (80% higher 5-year risk, 70% higher 10-year risk).
Limited access to care and complex social determinants of health have contributed to health disparities in American Indian communities, including high Type 2 diabetes rates. Lack of representation in research has led to underreporting of disease burden in this population.