Howard B V, Lee E T, Cowan L D, Fabsitz R R, Howard W J, Oopik A J, Robbins D C, Savage P J, Yeh J L, Welty T K
Medlantic Research Institute, Washington, DC 20010-2933, USA.
Am J Epidemiol. 1995 Aug 1;142(3):254-68. doi: 10.1093/oxfordjournals.aje.a117632.
Although coronary heart disease (CHD) is currently the leading cause of death among American Indians, information on the prevalence of CHD and its association with known cardiovascular risk factors is limited. The Strong Heart Study was initiated in 1988 to quantify cardiovascular disease and its risk factors among three geographically diverse groups of American Indians. Members of 13 Indian communities in Arizona, Oklahoma, and South and North Dakota between 45 and 74 years of age underwent a physical examination that included medical history; an electrocardiogram; anthropometric and blood pressure measurements; an oral glucose tolerance test; and measurements of fasting plasma lipoproteins, fibrinogen, insulin, hemoglobin A1c, and urinary albumin. Prevalence rates of definite myocardial infarction and definite CHD were higher in men than in women at all three centers (p < 0.0001) and higher in those with diabetes mellitus (p = 0.002 in men and p = 0.0003 in women). Diabetes was associated with relatively higher prevalence rates of myocardial infarction (diabetic:nondiabetic prevalence ratio = 3.8 vs. 1.9) and CHD (prevalence ratio = 4.6 vs. 1.8) in women than in men. Prevalence rates of heart disease were lowest in the communities in Arizona; prevalence rates were similar in Oklahoma and South Dakota/North Dakota and were two- to threefold higher than those in Arizona. By logistic regression, prevalent CHD among American Indians was significantly and independently related to age, diabetes, hypertension, albuminuria, percentage of body fat, smoking, high concentrations of plasma insulin, and low concentrations of high density lipoprotein cholesterol. In contrast to reports from other non-Indian populations, diabetes was the strongest risk factor. The lower prevalence of CHD among Indians in Arizona is distinctive in view of their higher rates of diabetes, obesity, hypertension, and albuminuria, but it may be partly related to their low frequency of smoking and their low concentrations of total and low density lipoprotein cholesterol. These findings from the initial Strong Heart Study examination emphasize the importance of diabetes and its associated variables as risk factors for CHD in Native American populations.
尽管冠心病（CHD）目前是美国印第安人死亡的主要原因，但关于冠心病患病率及其与已知心血管危险因素之间关联的信息有限。“强心研究”于1988年启动，旨在量化三类地理位置不同的美国印第安人群体中的心血管疾病及其危险因素。亚利桑那州、俄克拉何马州以及南达科他州和北达科他州13个印第安社区中45至74岁的成员接受了包括病史、心电图、人体测量和血压测量、口服葡萄糖耐量试验以及空腹血浆脂蛋白、纤维蛋白原、胰岛素、糖化血红蛋白A1c和尿白蛋白测量在内的体格检查。在所有三个中心，确诊心肌梗死和确诊冠心病的患病率男性均高于女性（p < 0.0001），糖尿病患者的患病率更高（男性p = 0.002，女性p = 0.0003）。与男性相比，糖尿病在女性中与相对较高的心肌梗死患病率（糖尿病：非糖尿病患病率比 = 3.8对1.9）和冠心病患病率（患病率比 = 4.6对1.8）相关。心脏病患病率在亚利桑那州的社区中最低；俄克拉何马州以及南达科他州/北达科他州的患病率相似，且比亚利桑那州高两到三倍。通过逻辑回归分析，美国印第安人中现患冠心病与年龄、糖尿病、高血压、蛋白尿、体脂百分比、吸烟、高血浆胰岛素浓度以及低高密度脂蛋白胆固醇浓度显著且独立相关。与其他非印第安人群的报告不同，糖尿病是最强的危险因素。鉴于亚利桑那州印第安人糖尿病、肥胖、高血压和蛋白尿的发生率较高，其冠心病患病率较低很独特，但这可能部分与他们吸烟频率低以及总胆固醇和低密度脂蛋白胆固醇浓度低有关。“强心研究”首次检查的这些结果强调了糖尿病及其相关变量作为美国原住民人群冠心病危险因素的重要性。
