Lumbee Native Americans have higher cardiovascular risks

March 12, 2006

The Lumbees of south central North Carolina -- the second largest Native American tribe east of the Mississippi River -- have a significantly higher burden of cardiovascular risk factors than do similar non-Lumbees, according to a new analysis by Duke Clinical Research Institute researchers. They said their findings exemplify the need to identify specific groups most vulnerable to heart disease, so that appropriate health care resources can be marshaled to help them.

While the researchers found that the Lumbees who came to the hospital for heart treatment had significantly higher rates of such risk factors as diabetes, hypertension and prior history of coronary artery disease and heart attack, they also tended to be younger and more likely to be female. They were also more likely to receive angioplasty during their hospitalization than non-Lumbees, found the researchers.

Furthermore, nine years after the initial hospitalization, the Lumbees had similar mortality rates as non-Lumbees, yet they were more likely to have suffered from at least one non-fatal heart attack during that time. The Lumbees also had lower rates of heart procedures - whether angioplasty or coronary artery bypass surgery - to re-open clogged coronary arteries during that nine-year period. The researchers said that the sometimes mixed findings should not only spur more research into how Lumbees can receive improved care after having been diagnosed with heart disease, but also on strategies for improving primary prevention measures to forestall heart disease in the first place.

"With health care and heart care costs rising in the U.S., it is very important to identify groups of patients who are at the greatest risk in order to develop strategies to help them," said Druenell Linton, M.D., Duke internal medicine resident who presented the results of the Duke study March 12, 2006, during the 55th annual scientific sessions of the American College of Cardiology in Atlanta.

"Identifying those groups, like we have in this study, marks a first step in this process of improving health care outcomes and addressing disparities in health care," Linton continued. "In order to improve delivery of, or access to, health care, it is important to first show the need. It would appear from our data that the Lumbees may have more severe disease compared to the general population."

It is estimated that there are more than 50,000 Lumbees, living primarily in the Robeson County area of North Carolina. While previous studies have shown that Native Americans in general have greater rates of cardiovascular disease, little research has been conducted about the incidence of heart disease and risk factors in the Lumbee population.

"Native Americans have a lot more cardiovascular disease than the population in general, but what we don't know is how much of their increased risk is due to their genetic background and how that background is modified by Western lifestyles and environmental factors," said Duke cardiologist Kristin Newby, M.D., senior member of the research team.

"As a clinician who takes care of many Lumbees, I think the findings from this analysis are truly impressive, particularly the findings that they tend to be younger and more likely female," Newby continued. "These results raise important questions that will need to be addressed."

For the study, the investigators consulted the Duke Databank for Cardiovascular Disease, which has been collecting data on patients who have received a heart procedure at Duke since 1969. The researchers identified 920 Lumbees who had received a cardiac catheterization. From the same databank, the researchers identified 2,763 random non-Lumbees to serve as a comparison.

The researchers found statistically significant differences between Lumbees and non-Lumbees in age (60 vs. 64), hypertension (70.9 percent vs. 62.5 percent), diabetes (37.6 percent vs. 28.1 percent), prior heart attack (60.6 percent vs. 49.9 percent) family history of heart disease (51.7 percent vs. 38.8 percent) and obesity (29 percent vs. 27.5 percent).

"What we found particularly interesting was that when they came to the hospital, the Lumbees tended to be younger than non-Lumbees; however they presented with a higher incidence of a prior heart attack or prior heart revascularization procedure," Linton said. Specifically, 16 percent of Lumbees had already had an angioplasty procedure, compared to 6.5 percent for non-Lumbees.

Another interesting finding deals with the drugs known to reduce the risks of future events that are prescribed to heart patients after discharge from the hospital. Within 30 days of catheterization, fewer Lumbees were taking statins (19.8 percent vs. 24.7 percent), ACE inhibitors (13 percent vs. 15.5 percent), beta blockers (40.6 percent vs. 46.9 percent) and aspirin (67.6 percent vs. 74.3 percent).
The Duke team, led by Svati Shah, M.D., is also currently investigating the genetic characteristics of cardiovascular disease in the Lumbees. Since Duke has been collecting genetic material on all patients who receive a catheterization at Duke, the team hopes to correlate genetic information with clinical characteristics and subsequent outcomes.

Other members of the Duke team were Adrian Hernandez, M.D., and Robert Tuttle.

Duke University Medical Center

Related Heart Disease Articles from Brightsurf:

Cellular pathway of genetic heart disease similar to neurodegenerative disease
Research on a genetic heart disease has uncovered a new and unexpected mechanism for heart failure.

Mechanism linking gum disease to heart disease, other inflammatory conditions discovered
The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery.

New 'atlas' of human heart cells first step toward precision treatments for heart disease
Scientists have for the first time documented all of the different cell types and genes expressed in the healthy human heart, in research published in the journal Nature.

With a heavy heart: How men and women develop heart disease differently
A new study by researchers from McGill University has uncovered that minerals causing aortic heart valve blockage in men and women are different, a discovery that could change how heart disease is diagnosed and treated.

Heart-healthy diets are naturally low in dietary cholesterol and can help to reduce the risk of heart disease and stroke
Eating a heart-healthy dietary pattern rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, vegetable oils and nuts, which is also limits salt, red and processed meats, refined-carbohydrates and added sugars, is relatively low in dietary cholesterol and supports healthy levels of artery-clogging LDL cholesterol.

Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.

Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.

New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.

Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.

Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.

Read More: Heart Disease News and Heart Disease Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to