Abstract
BackgroundOf the estimated 10–11 year life expectancy gap between Indigenous (Aboriginal and Torres Strait Islander people) and non-Indigenous Australians, approximately one quarter is attributable to cardiovascular disease (CVD). Risk prediction of CVD is imperfect, but particularly limited for Indigenous Australians. The BIRCH (Better Indigenous Risk stratification for Cardiac Health) project aims to identify and assess existing and novel markers of early disease and risk in Indigenous Australians to optimise health outcomes in this disadvantaged population. It further aims to determine whether these markers are relevant in non-Indigenous Australians.Methods/designBIRCH is a cross-sectional and prospective cohort study of Indigenous and non-Indigenous Australian adults (≥ 18 years) living in remote, regional and urban locations. Participants will be assessed for CVD risk factors, left ventricular mass and strain via echocardiography, sleep disordered breathing and quality via home-based polysomnography or actigraphy respectively, and plasma lipidomic profiles via mass spectrometry. Outcome data will comprise CVD events and death over a period of five years.DiscussionResults of BIRCH may increase understanding regarding the factors underlying the increased burden of CVD in Indigenous Australians in this setting. Further, it may identify novel markers of early disease and risk to inform the development of more accurate prediction equations. Better identification of at-risk individuals will promote more effective primary and secondary preventive initiatives to reduce Indigenous Australian health disadvantage.
Highlights
Of the estimated 10–11 year life expectancy gap between Indigenous (Aboriginal and Torres Strait Islander people) and non-Indigenous Australians, approximately one quarter is attributable to cardiovascular disease (CVD)
This paper describes the BIRCH (Better Indigenous Risk stratification for Cardiac Health) project that aims to assess cardiovascular risk and explore the potential value of novel cardiovascular risk factors and early disease markers in Indigenous Australians
Despite CVD being a major contributor to overall health disadvantage in Indigenous Australians, there exist significant deficiencies in currently used CVD prediction tools
Summary
CVD risk assessment in disadvantaged populations, including Indigenous Australians, remains an ongoing challenge. While many existing and newer markers of early CVD disease or risk may help identify Indigenous Australians at increased risk of development of overt CVD, the BIRCH project focuses on three markers comprising: sleep quality and disorders, left ventricular function and morphology, and select lipidomic species. These markers were chosen as they are potential targets for primary and/or secondary prevention in this setting.
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