Merone Lea, McDermott Robyn, Mein Jacki, Clarke Philip, McDonald Malcolm
Centre for Chronic Disease Prevention, James Cook University, Brisbane, Qld, Australia; Apunipima Cape York Health Council, Bungalow, Qld, Australia.
Centre for Chronic Disease Prevention, James Cook University, Brisbane, Qld, Australia; Apunipima Cape York Health Council, Bungalow, Qld, Australia; School of Population Health, University of South Australia, Adelaide, SA, Australia.
Heart Lung Circ. 2020 Sep;29(9):1278-1291. doi: 10.1016/j.hlc.2019.06.720. Epub 2019 Jul 8.
Cardiovascular disease (CVD) is the commonest cause of death across the globe; incidence and prevalence rates are increasing. Together, CVD and diabetes mellitus are responsible for a quarter of the health gap observed between Aboriginal Australians and Torres Strait Islanders, and non-Indigenous Australians. Numerous programs have been proposed and implemented to Close the Gap; ideally, these should be evidence-based.
The aim of this review is to evaluate primary prevention measures and programs that aim to reduce CVD risk in minority Indigenous populations around the world.
A search of PubMed, the Cochrane Library and the Elsevier Scopus Database was initially conducted using the terms "cardiovascular disease", "population groups", "primary prevention", "health services, indigenous", "indigenous health", "risk assessment" and "risk management". Results were then assessed per inclusion/exclusion criteria. A second reviewer independently evaluated the publications and review process to ensure agreement.
The initial search produced 37 publications; 19 met the inclusion criteria and were incorporated into a comparative table. Most were descriptive, mixed-methods, audit or intervention studies. Heterogeneity of study design prevented statistical analysis.
Addressing CVD risk in minority Indigenous populations is a multifactorial challenge; there is substantial room for improvement in routine risk assessment and management. Holistic approaches need to embrace local cultural perceptions of health and wellbeing. Validated risk reduction tools, individualised management plans, polypills and computer based decision support tools are promising to improve outcomes for those at risk.
心血管疾病（CVD）是全球最常见的死亡原因；其发病率和患病率正在上升。心血管疾病和糖尿病共同导致了澳大利亚原住民和托雷斯海峡岛民与非原住民澳大利亚人之间观察到的四分之一的健康差距。已经提出并实施了许多缩小差距的计划；理想情况下，这些计划应该基于证据。
本综述的目的是评估旨在降低世界各地少数原住民群体心血管疾病风险的一级预防措施和计划。
最初在PubMed、Cochrane图书馆和爱思唯尔Scopus数据库中进行检索，使用的检索词为“心血管疾病”、“人群组”、“一级预防”、“原住民健康服务”、“原住民健康”、“风险评估”和“风险管理”。然后根据纳入/排除标准对结果进行评估。另一位评审员独立评估这些出版物和评审过程以确保一致性。
初步检索产生了37篇出版物；19篇符合纳入标准并被纳入一个比较表中。大多数是描述性、混合方法、审计或干预研究。研究设计的异质性妨碍了统计分析。
应对少数原住民群体的心血管疾病风险是一项多因素挑战；常规风险评估和管理仍有很大的改进空间。整体方法需要考虑当地对健康和幸福的文化认知。经过验证的风险降低工具、个性化管理计划、复方药丸和基于计算机的决策支持工具有望改善高危人群的结局。
