American Journal of Epidemiology Vol. 132, No. 6: 1141-1155
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health
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THE STRONG HEART STUDY A STUDY OF CARDIOVASCULAR DISEASE IN AMERICAN INDIANS: DESIGN AND METHODS
1University of Oklahoma Health Sciences Center Oklahoma City, OK
2Public Health Service Indian Hospital Rapid City, SD
3National Heart, Lung, and Blood Institute Bethesda, MD
4Mediantic Research Foundation Washington, DC
5Fitzsimons Army Medical Center Denver, CO
Available data indicate that cardiovascular disease has become the leading cause of death in American Indians. However, limited information is available on cardiovascular disease incidence, prevalence, and risk factors in this population. Reported cardiovascular disease rates vary greatly among groups in different geographic areas. These rates have been obtained from studies of varying sizes and different methodologies. The Strong Heart Study, which uses standardized methodology, is designed to estimate cardiovascular disease mortality and morbidity rates and the prevalence of known and suspected cardiovascular disease risk factors in American Indians. The study population consists of 12 tribes in three geographic areas: an area near Phoenix, Arizona, the southwestern area of Oklahoma, and the Aberdeen area of North and South Dakota. The study includes three components. The first is a mortality survey to estimate cardiovas cular disease mortality rates for 1984–1988 among tribal members aged 35–74 years, and the second is a morbidity survey to estimate incidence of both first and first or recurrent hospitalized myocardial infarction and stroke (cerebrovas cular disease) among tribal members aged 45–74 years in 1984–1988, and the third is a clinical examination of 4,500 tribal members aged 45–74 years in order to estimate the prevalence of cardiovascular disease and its associations with risk factors. Family history, diet, alcohol and tobacco consumption, physical activity, degree of acculturation, and socioeconomic status are assessed in personal interviews. The physical examination includes measurements of body fat, body circumferences, and blood pressure, an examination of the heart and lungs, an evaluation of peripheral vascular disease, and a 12-lead electrocardiogram. Laboratory measurements include fasting and postload glucose, insulin, fasting lipids, apoproteins, fibi-inogen, and glycated hemoglobin. Also measured are serum and urine creatinine and urinary albumin. DNA from lymphocytes is isolated and stored for future genetic studies.
cardiovascular disease; Indians, North American; mortality
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A. Ilercil, R. B. Devereux, M. J. Roman, M. Paranicas, M. J. O'Grady, E. T. Lee, T. K. Welty, R. R. Fabsitz, and B. V. Howard Associations of Insulin Levels With Left Ventricular Structure and Function in American Indians : The Strong Heart Study Diabetes, May 1, 2002; 51(5): 1543 - 1547. [Abstract] [Full Text] [PDF]
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Y. Zhang, B. V. Howard, L. D. Cowan, J. Yeh, C. F. Schaefer, R. A. Wild, W. Wang, and E. T. Lee The Effect of Estrogen Use on Levels of Glucose and Insulin and the Risk of Type 2 Diabetes in American Indian Postmenopausal Women : The Strong Heart Study Diabetes Care, March 1, 2002; 25(3): 500 - 504. [Abstract] [Full Text] [PDF]
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V. Palmieri, A. Celentano, M. J. Roman, G. de Simone, M. R. Lewis, L. Best, E. T. Lee, D. C. Robbins, B. V. Howard, and R. B. Devereux Fibrinogen and Preclinical Echocardiographic Target Organ Damage: The Strong Heart Study Hypertension, November 1, 2001; 38(5): 1068 - 1074. [Abstract] [Full Text] [PDF]
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M. S. Marion, G. R. Leonardson, E. R. Rhoades, T. K. Welty, and P. L. Enright Spirometry Reference Values for American Indian Adults : Results From the Strong Heart Study Chest, August 1, 2001; 120(2): 489 - 495. [Abstract] [Full Text] [PDF]
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 R. B. D'Agostino, Sr, S. Grundy, L. M. Sullivan, P. Wilson, and for the CHD Risk Prediction Group Validation of the Framingham Coronary Heart Disease Prediction Scores: Results of a Multiple Ethnic Groups Investigation JAMA, July 11, 2001; 286(2): 180 - 187. [Abstract] [Full Text] [PDF]
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N. E. Lebowitz, J. N. Bella, M. J. Roman, J. E. Liu, D. P. Fishman, M. Paranicas, E. T. Lee, R. R. Fabsitz, T. K. Welty, B. V. Howard, et al. Prevalence and correlates of aortic regurgitation in american indians: the Strong Heart Study J. Am. Coll. Cardiol., August 1, 2000; 36(2): 461 - 467. [Abstract] [Full Text] [PDF]
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P. M. Okin, R. B. Devereux, B. V. Howard, R. R. Fabsitz, E. T. Lee, and T. K. Welty Assessment of QT Interval and QT Dispersion for Prediction of All-Cause and Cardiovascular Mortality in American Indians : The Strong Heart Study Circulation, January 4, 2000; 101(1): 61 - 66. [Abstract] [Full Text] [PDF]
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B. V. Howard, E. T. Lee, L. D. Cowan, R. B. Devereux, J. M. Galloway, O. T. Go, W. J. Howard, E. R. Rhoades, D. C. Robbins, M. L. Sievers, et al. Rising Tide of Cardiovascular Disease in American Indians : The Strong Heart Study Circulation, May 11, 1999; 99(18): 2389 - 2395. [Abstract] [Full Text] [PDF]
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R. S. Gray, D. C. Robbins, W. Wang, J. L. Yeh, R. R. Fabsitz, L. D. Cowan, T. K. Welty, E. T. Lee, R. M. Krauss, and B. V. Howard Relation of LDL Size to the Insulin Resistance Syndrome and Coronary Heart Disease in American Indians : The Strong Heart Study Arterioscler Thromb Vasc Biol, November 1, 1997; 17(11): 2713 - 2720. [Abstract] [Full Text]
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L. L. White, H. I. Goldberg, T. J. Gilbert, C. Ballew, J. M. Mendlein, D. G. Peter, C. A. Percy, and A. H. Mokdad Rationale, Design and Methodology for the Navajo Health and Nutrition Survey J. Nutr., October 1, 1997; 127(10): 2078 - 2078. [Abstract] [Full Text]
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S. Kataoka, D. C. Robbins, L. D. Cowan, O. Go, J. L. Yeh, R. B. Devereux, R. R. Fabsitz, E. T. Lee, T. K. Welty, and B. V. Howard Apolipoprotein E Polymorphism in American Indians and Its Relation to Plasma Lipoproteins and Diabetes: The Strong Heart Study Arterioscler Thromb Vasc Biol, August 1, 1996; 16(8): 918 - 925. [Abstract] [Full Text]
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B. V. Howard, E. T. Lee, J. L. Yeh, O. Go, R. R. Fabsitz, R. B. Devereux, and T. K. Welty Hypertension in Adult American Indians: The Strong Heart Study Hypertension, August 1, 1996; 28(2): 256 - 264. [Abstract] [Full Text]
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R. F. Gillum The Epidemiology of Stroke in Native Americans Stroke, March 1, 1995; 26(3): 514 - 521. [Abstract] [Full Text]
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 M. A. Mori, G. Leonardson, and T. K. Welty The Benefits of Isoniazid Chemoprophylaxis and Risk Factors for Tuberculosis Among Oglala Sioux Indians Arch Intern Med, March 1, 1992; 152(3): 547 - 550. [Abstract] [PDF]
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P. M. Okin, R. B. Devereux, R. R. Fabsitz, E. T. Lee, J. M. Galloway, and B. V. Howard Principal Component Analysis of the T Wave and Prediction of Cardiovascular Mortality in American Indians: The Strong Heart Study Circulation, February 12, 2002; 105(6): 714 - 719. [Abstract] [Full Text] [PDF]
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J. N. Bella, V. Palmieri, M. J. Roman, J. E. Liu, T. K. Welty, E. T. Lee, R. R. Fabsitz, B. V. Howard, and R. B. Devereux Mitral Ratio of Peak Early to Late Diastolic Filling Velocity as a Predictor of Mortality in Middle-Aged and Elderly Adults: The Strong Heart Study Circulation, April 23, 2002; 105(16): 1928 - 1933. [Abstract] [Full Text] [PDF]
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