Approaches to cardiovascular disease and its treatment.

Abstract

This is the third of a series of articles reviewing presentations at the 63rd annual scientific session of the American Diabetes Association (ADA), held in New Orleans, Louisiana, June 2003. Barbara Howard (Hyattsville, MD) gave the Kelley West lecture, in which she discussed the Strong Heart Study and the relationship between diabetes and cardiovascular disease (CVD). The study, which began in 1988 in three American Indian communities, describes “the epidemic of CVD and diabetes among this population.” A total of 4,549 individuals age 45–74 years of age living in the Hela River Indian reservation in Arizona, including Pima, Sioux, and Dakota Indians, were studied with examinations at 5-year intervals and ongoing yearly surveillance of CVD mortality and events. Comparing the study population with their counterparts in the general populations of North and South Dakota, Arizona, and Oklahoma, levels of total and CVD mortality are ∼2-fold higher among women and 1.5-fold higher among men. Similarly, carotid ultrasound studies show increased atherosclerosis among Indian men and women compared with other populations. There also appear to be trends to increasing CVD rates over the decade of the study. Diabetes is very prevalent among American Indian communities. In the Strong Heart Study, rates exceed 60% in Arizona and 40% in the Oklahoma and Dakota groups. At 8-year follow-up, CVD rates are markedly increased among people with diabetes; coronary heart disease (CHD) risks are eight- and threefold higher among women and men with diabetes, respectively. If, as Howard suggested, CVD takes 15–20 years to develop, one would expect a lag time of approximately this duration between the development of diabetes and that of CVD. This appears to be the case in the studied population, suggesting that the current epidemic of diabetes in the U.S. population will result in an increase in CVD rates, reversing current …