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Cardiovascular Risk Factors in Native American Children ANN s. BOTASH,~RAEELLEN w. K A V E Y , ~ NANCY EMM,b AND DIANE JONES ‘Department of Pediatrics bDepartment of Pediatric Cardiology State University of New York Health Science Center 750 East Adams Street Syracuse, New York 13210 ‘Health Department Onondaga Nation School Route I I Nedrow, New York I3120
In adult Native Americans (NAs), recent reports indicate increasing mortality from cardiovascular disease (CVD).l,2 Specific NA communities have a high prevalence of non-insulin-dependent diabetes niellitus (DM), hypertension, obesity, and cigarette There are no previous studies of CVD risk among Onondaga Nation NAs; risk factor data in N A children in general are scarce. Fifty-five of 95 children enrolled at the Onondaga Nation School, ages 5-16 years, voluntarily participated in a CVD risk factor screening. Thirty-nine interrelated families were represented. All participants lived on Onondaga Nation Territory, a primarily Onondaga and Mohawk population. Six risk factors were a s s e ~ s e d passive :~ smoking, family history of DM, family history of CVD, obesity, hypertension,and hypercholesterolemia. Telephone interviews with parents revealed 90% of families had household members who snioked cigarettes6 Family histories of first- and second-degree relatives were positive for DM in 72% and CVD in 54%.’ Physical examination of the children revealed obesity (weight/height 2 90th percentile)* in 42% and hypertension (resting right arm systolic or diastolic blood pressure/height 2 95th percentile)’ in 22%. Ten of these 12 hypertensive children had weight/height ratios greater than the 95th percentile. Nonfasting finger-stick cholesterols (Reflotron System, Boehringer MannThe mean heim Diagnostics, Indianapolis, Ind.) were 2 170 mg/dl in 25% (FIG. serum cholesterol was 146 mg/dl. Overall, 85% of participants had three or more CVD risk factors (FIG.2). Although this community may have a genetic predisposition to DM and CVD,4 modifiable risk factors of obesity, passive smoking, hypercholesterolemia, and hypertension are prevalent. The study results suggest that Native American children are at significant risk for CVD; programs for identification and modification of CVD risk factors are urgently needed. 416
417
BOTASH el al.: NATIVE AMERICAN CHILDREN
250
PERCENTILE
I 230
J ; ---t-
210
-
~
1
I
190
170
150
-l 130
V _' ___
110
I--]-
I 6
8
10
12
AGE (years)
FIGURE 1. Serum cholesterol percentiles of Native American children. Based on a reference grid developed by Cresanta, el al. lo
ANNALS NEW YORK ACADEMY OF SCIENCES
418
2o
1
10
0 0
1
2
3
4
5
6
Number of Risk Factors FIGURE 2. Cardiovascular disease risk factors: passive smoking, family history of DM, family history of CVD, obesity, hypertension, and hypercholesterolemia.
REFERENCES 1. HRABOVSKY, S. L., T. K. WELTY& J. L. COULEHAN. 1989. Acute myocardial infarction and sudden death in Sioux Indians. West. J. Med. 150(4): 420-422. 2. KLAIN,M., J. L COULEHAN, V. C. ARENA& R. JANETT.1988. More frequent diagnosis of acute myocardial infarction among Navajo Indians. Am. J. Public Health %(lo): 1351- 1352. 3. GILLUM, R. F., B. S. GILLUM& N. SMITH.1984. Cardiovascular risk factors among urban American Indians: blood pressure, serum lipids, smoking, diabetes, health knowledge and behavior. Am. Heart J. 107(4): 765-776. 4. MACAULEY, A. C., L. T. MONTOUR& N. ADELSON.1988. Prevalence of diabetic and atherosclerotic complications among Mohawk Indians of Kahnawake, PQ. Can. Med. Assoc. J. 139: 221-224. G. S . , S. R. SRINIVASON, 5 . BERENSON, S. M. HUNTER,T. A. NICKLAS,D. S. FREEDMAN, C. L. SHEAR& L. S. WEBBER.1989. Risk factors in early life as predictors of adult heart disease: the Bogalusa Heart Study. Am. J. Med. Sci. 298(3): 141-151. 6. MOSKOWITZ, W. B., M. MOSTELLER,R. BOSSANO,ef al. 1987. Does passive smoking increase coronary heart disease risk in pubertal boys? (abstr.) Circulation 76: IV-359. & G. S. BERENSON.1981. Parental history 7. BLONDE,C. V., L. S. WEBBER,T. A. FOSTER and cardiovascular disease risk factor variables in children. Prev. Med. 10 25-37. 8. HAMILL,P. V., T. A. DRIZEL,C. L. JOHNSON, et al. 1979. Physical growth National Center for Health Statistics percentiles. Am. J. Clin. Nutr. 32: 607-629. 9. BERENSON,G. S., J. L. CRESANTA& L. S. WEBBER.1984. High blood pressure in the young. Annu. Rev. Med. 35: 535-560. J. L., S. R. SRINIVASAN, L. S. WEBBER& G. S. BERENSON.1984. Serum lipid 10. CRESANTA, and lipoprotein cholesterol grids for cardiovascular risk screening of children. Am. J. Dis. Child. 138: 379-387.
Cardiovascular Risk Factors in Native American Children ANN s. BOTASH,~RAEELLEN w. K A V E Y , ~ NANCY EMM,b AND DIANE JONES ‘Department of Pediatrics bDepartment of Pediatric Cardiology State University of New York Health Science Center 750 East Adams Street Syracuse, New York 13210 ‘Health Department Onondaga Nation School Route I I Nedrow, New York I3120
In adult Native Americans (NAs), recent reports indicate increasing mortality from cardiovascular disease (CVD).l,2 Specific NA communities have a high prevalence of non-insulin-dependent diabetes niellitus (DM), hypertension, obesity, and cigarette There are no previous studies of CVD risk among Onondaga Nation NAs; risk factor data in N A children in general are scarce. Fifty-five of 95 children enrolled at the Onondaga Nation School, ages 5-16 years, voluntarily participated in a CVD risk factor screening. Thirty-nine interrelated families were represented. All participants lived on Onondaga Nation Territory, a primarily Onondaga and Mohawk population. Six risk factors were a s s e ~ s e d passive :~ smoking, family history of DM, family history of CVD, obesity, hypertension,and hypercholesterolemia. Telephone interviews with parents revealed 90% of families had household members who snioked cigarettes6 Family histories of first- and second-degree relatives were positive for DM in 72% and CVD in 54%.’ Physical examination of the children revealed obesity (weight/height 2 90th percentile)* in 42% and hypertension (resting right arm systolic or diastolic blood pressure/height 2 95th percentile)’ in 22%. Ten of these 12 hypertensive children had weight/height ratios greater than the 95th percentile. Nonfasting finger-stick cholesterols (Reflotron System, Boehringer MannThe mean heim Diagnostics, Indianapolis, Ind.) were 2 170 mg/dl in 25% (FIG. serum cholesterol was 146 mg/dl. Overall, 85% of participants had three or more CVD risk factors (FIG.2). Although this community may have a genetic predisposition to DM and CVD,4 modifiable risk factors of obesity, passive smoking, hypercholesterolemia, and hypertension are prevalent. The study results suggest that Native American children are at significant risk for CVD; programs for identification and modification of CVD risk factors are urgently needed. 416
417
BOTASH el al.: NATIVE AMERICAN CHILDREN
250
PERCENTILE
I 230
J ; ---t-
210
-
~
1
I
190
170
150
-l 130
V _' ___
110
I--]-
I 6
8
10
12
AGE (years)
FIGURE 1. Serum cholesterol percentiles of Native American children. Based on a reference grid developed by Cresanta, el al. lo
ANNALS NEW YORK ACADEMY OF SCIENCES
418
2o
1
10
0 0
1
2
3
4
5
6
Number of Risk Factors FIGURE 2. Cardiovascular disease risk factors: passive smoking, family history of DM, family history of CVD, obesity, hypertension, and hypercholesterolemia.
REFERENCES 1. HRABOVSKY, S. L., T. K. WELTY& J. L. COULEHAN. 1989. Acute myocardial infarction and sudden death in Sioux Indians. West. J. Med. 150(4): 420-422. 2. KLAIN,M., J. L COULEHAN, V. C. ARENA& R. JANETT.1988. More frequent diagnosis of acute myocardial infarction among Navajo Indians. Am. J. Public Health %(lo): 1351- 1352. 3. GILLUM, R. F., B. S. GILLUM& N. SMITH.1984. Cardiovascular risk factors among urban American Indians: blood pressure, serum lipids, smoking, diabetes, health knowledge and behavior. Am. Heart J. 107(4): 765-776. 4. MACAULEY, A. C., L. T. MONTOUR& N. ADELSON.1988. Prevalence of diabetic and atherosclerotic complications among Mohawk Indians of Kahnawake, PQ. Can. Med. Assoc. J. 139: 221-224. G. S . , S. R. SRINIVASON, 5 . BERENSON, S. M. HUNTER,T. A. NICKLAS,D. S. FREEDMAN, C. L. SHEAR& L. S. WEBBER.1989. Risk factors in early life as predictors of adult heart disease: the Bogalusa Heart Study. Am. J. Med. Sci. 298(3): 141-151. 6. MOSKOWITZ, W. B., M. MOSTELLER,R. BOSSANO,ef al. 1987. Does passive smoking increase coronary heart disease risk in pubertal boys? (abstr.) Circulation 76: IV-359. & G. S. BERENSON.1981. Parental history 7. BLONDE,C. V., L. S. WEBBER,T. A. FOSTER and cardiovascular disease risk factor variables in children. Prev. Med. 10 25-37. 8. HAMILL,P. V., T. A. DRIZEL,C. L. JOHNSON, et al. 1979. Physical growth National Center for Health Statistics percentiles. Am. J. Clin. Nutr. 32: 607-629. 9. BERENSON,G. S., J. L. CRESANTA& L. S. WEBBER.1984. High blood pressure in the young. Annu. Rev. Med. 35: 535-560. J. L., S. R. SRINIVASAN, L. S. WEBBER& G. S. BERENSON.1984. Serum lipid 10. CRESANTA, and lipoprotein cholesterol grids for cardiovascular risk screening of children. Am. J. Dis. Child. 138: 379-387.
