Native Americans (American Indians)

When the Strong Heart Study was initiated in 1988 to investigate cardiovascular disease and its risk factors in diverse groups of Native Americans (American Indians) in the United States, prevalence data from the initial examination suggested that at least some Native American tribal groups had lower rates of myocardial infarction and CHD than other U.S. groups. However, recent data from the Indian Health Service indicate that CVD mortality rates vary among the American Indian communities and appear to be increasing. CHD incidence rates among Native American men and women were almost twice as high as those in the biracial Atherosclerosis Risk in Communities Study and CHD appeared more often to be fatal. The significant independent predictors of CVD in Native American women were diabetes, age, obesity, LDL, albuminuria, triglycerides, and hypertension. In men the significant predictors of CVD were diabetes, age, LDL, albuminuria, and hypertension. Interestingly, and unlike other ethnic groups, Native Americans appear to have an increasing incidence of CHD, possibly related to the high and increasing prevalence of diabetes in these communities. At a recent NHLBI workshop on risk assessment, the cardiovascular risk score in Native American women appeared to overestimate actual risk. Although no separate algorithm for lipid management should be recommended for Native Americans, efforts to reduce cholesterol and other CHD risk factors in this population are especially important because of the higher CHD incidence and the suggestion of apparently higher associated mortality rates. The importance of LDL cholesterol as a contributor to CHD in this group should not be underestimated merely because total and LDL-cholesterol levels are lower than the U.S. average. Moreover, because of the high frequency of type 2 diabetes, many Native Americans will have an even lower LDL goal.

In summary, despite limited data suggesting some differences in baseline risk between Native American and white populations, the ATP III panel concludes that the evidence for differences is not strong enough to justify separate guidelines for Native American populations. Consequently no separate algorithm for lipid management is recommended and the same guidelines and risk stratification groupings are appropriate for Native Americans as for other populations.