Cardiovascular health among American Indians and Alaska Natives: successes, challenges, and potentials.

With low rates of the risk factors for cardiovascular disease as recently as 40 years ago, the rates of cardiovascular disease (CVD) in American Indians and Alaska Natives were exceedingly low. Despite recent large-scale efforts to eliminate health disparities in ethnic and minority populations, the impact among American Indian and Alaska Natives to date has been relatively limited. Indeed, over the past several decades the incidence and prevalence of cardiovascular risk factors has risen significantly, including the development of an epidemic of diabetes. Evidence suggests that these higher rates of cardiovascular risk factors, including tobacco abuse, diabetes, high blood pressure, and elevated cholesterol levels, may be placing an inordinate burden of cardiovascular disease on the American Indian and Alaska Native population. The rates of heart disease and stroke among American Indians and Alaska Natives are now higher than in the general U.S. population as well as in U.S. whites. Recent evaluations suggest that these rates are also higher than among other ethnic or racial populations in the United States. Additionally, American Indians and Alaska Natives have been found to have a substantially higher proportion of premature death from heart disease when compared with other ethnic and racial populations. A number of recent prevention initiatives and focused clinical efforts are making promising strides toward reduced disparities in cardiovascular health with primordial, primary, and secondary cardiovascular prevention efforts along with enhanced early identification and therapeutic intervention for more favorable cardiovascular outcomes in the future. In order to reach our goals of heart-healthy and stroke-free American Indians and Alaska Natives, implementation of an aggressive, reasonably resourced, systemic plan of coordinated health promotion, risk reduction, and disease control efforts are necessary, with appropriate policy and legislative support.