Cardiovascular disease (CVD),
also known as heart disease, is the disease of heart and circulation. Types of
CVD include angina, heart attack, stroke, heart valve disease, heart failure
and cardiomyopathy. There are several risk factors for CVD, the most noteworthy
being obesity, high blood pressure, high blood cholesterol, physical
inactivity, smoking and even ethnic background.
According to the U.S. Department
of Health and Human Services, Office of Minority Health, American Indians and
Alaska Natives (AI / AN) are 1.4 times more likely to be obese (BMI=30 or more)
than their white counterparts, 1.3 times more likely to have high blood
pressure and 1.4 times more likely to be cigarette smokers than white adults.
Figures speak for themselves; no wonder the incidence of coronary heart disease
in them is twice as high as in their white counterparts.
Researchers can not pin point the
exact reasons for obesity and diabetes epidemic in these communities. Although
traditional diets vary by tribe and region, generally they are healthy and
include plant products, wild rice, roots, berries, nuts, and lean meats.
Similarly, these communities are physically very active - hunting, gathering,
fishing, canoeing, traditional dances and games such as hockey and lacrosse are
all part of their lifestyle. Some researchers suggested that switching to
unhealthy Western diets and lifestyles may probably be the cause of these
Tobacco is a sacred plant in many
ethnic cultures and is used in prayers and other rituals, found some studies.
Smoking cigarettes means not adhering to AI / AN culture but the data shows
otherwise. Here too, the researchers believe that the permissive attitudes of
modern society towards smoking and smoking behavior may be the reason.
Five controlled trials have been
initiated to test the effectiveness of community-responsive interventions to
promote healthy behaviors that can reduce cardiovascular risk in AI/AN
communities. Jared Jobe at the Division of Cardiovascular Sciences, National
Heart, Lung, and Blood Institute, Bethesda, USA, and his colleagues, have
discussed these trials and published them as an article in the Journal of Primary Prevention
In the first trial, the
interventions are designed to reduce body mass index (BMI) by altering feeding
practices in 600 infants and toddlers from the study communities. The
intervention includes promoting breastfeeding, reducing sugar-sweetened
beverage consumption, delaying solid food introduction, guiding introduction of
type of food, encouraging development of motor skills, and creating safe play
The second trial, Healthy Children, Strong Families
involves a home-based healthy lifestyle intervention for 150 AI families with
children ages 2-5 years. The intervention includes involving parents using an
intergenerational model, focusing on children, educating about nutrition, role
modeling, forming partnerships between organizations, and incorporating family
The third trial, A
Cardiovascular Risk Reduction Program for American Indians with Metabolic
Syndrome: The Balance Study
, involves 200 AI adults with metabolic
syndrome. The intervention comprises 'a holistic lifestyle modification program
with four components: cultural/spiritual, emotional/motivational, nutritional,
and physical fitness and exercise'. The intervention group attends sessions
which include discussions on AI culture and health, mental and physical health,
nutritional information and healthy cooking demonstrations, and physical
activities, such as walking, chair exercises, and AI dancing.
The fourth trial, enrolling 120
parents at risk for CVD, is about developing a non-stigmatizing intervention
with a focus on parents to promote intergenerational wellness and future
generations' health based on the community related domains of mind, body,
spirit, and emotion.
The fifth trial, initiated in
Lakota population residing on or near the Cheyenne River Sioux Reservation in
South Dakota, involves 180 adults with type-2 diabetes and dyslipidemia,
hypertension, or both. The goal of this trial is to 'determine whether a
web-based diabetes and nutritional intervention, which has previously been
found to improve diabetes control in disadvantaged inner-city populations, can
significantly reduce the risk of CVD in this population'.
'All five trials feature strong
community partnerships, culturally tailored interventions, and a comparison
group that receives benefits from participating in the study, consistent with
community standards', say the authors.
'The high burden of CVD among
AI/AN populations will worsen unless behaviors and lifestyles affecting CVD
risk can be modified. These five trials, if successful, represent a starting
point in addressing these significant health disparities', they conclude.
Jobe JB, Adams AK, Henderson JA, Karanja N, Lee ET,
Walters KL. Community-Responsive Interventions to Reduce Cardiovascular Risk in
American Indians. J Prim Prev. 2012;33(4):153-159. http://www.medscape.com/viewarticle/772106_1