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Welcome to the Website of the Strong Heart Study
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Arizona Center and Core Laboratory Barbara Howard, Ph. D., MedStar
Research Institute Dakotas Center Phase
I-II: Thomas K. Welty, M.D., Aberdeen
Area Indian Health Service Phase
III: Thomas K. Welty, M.D., Aberdeen Area Tribal Chairmen's Health
Board Phase
IV: Lyle Best, M. D., Missouri Breaks Industries Research, Inc. Oklahoma Center and Coordinating Center Elisa T. Lee, Ph. D., Center for American
Indian Health Research (CAIHR), University
of Oklahoma Health Sciences Center (OUHSC). ECG and Ultrasound Reading Center Richard B. Devereux, M. D., Division of Cardiology, the New York Presbyterian Hospital – Weill Medical College of Cornell
Medical Center. SHS Family Study Center Jean W. MacCluer, Ph. D., Department of Genetics, Southwest Foundation for Biomedical Research.
SHS has the following standing committees: Steering Committee ( Subcommittees: (
Participating
communities include 13 American Indian tribes and communities in four states:
Seven Tribes from Southwestern Oklahoma (Apache, Caddo, Comanche, Delaware,
Fort Sill Apache, Kiowa and Wichita), three tribes from Arizona (Gila River
and Salt River Pima/Maricopa, and Akchin Pima/Papago), and three Sioux Tribes
from South/North Dakota (SD/ND) (Oglala Sioux, Cheyenne River Sioux, and
Spirit Lake Communities).
The purpose of the Phase I exam was to measure the
extent of heart disease and heart disease risk factors among the three SHS
centers. The
Phase I exam was conducted between 1989 and 1991. 4549 tribal members, ages
45-74 years of age (62% of the total population ages 45-74 yrs) were seen. In
the Phase I examination, medical history, family history of related illness,
diet, alcohol and tobacco consumption, physical activity, degree of
acculturation, and socioeconomic status of the participants were assessed in
personal interviews. The physical examination included 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 resting
electrocardiogram (ECG). Laboratory measurements in the baseline exam
included fasting and post-load glucose and fasting insulin, fasting lipids,
apoproteins B and AI, apo E phenotype, fibrinogen, Lp(a), LDL size, Gm
allotype, and glycated hemoglobin. Measures were also made of urinary
creatinine and urinary albumin, and some blood samples were frozen and stored
for future analysis.
Most of the information about factors that increase
the risk of heart disease comes from non-Indian populations. We assume that
the same factors contribute to heart disease in Indians. To be sure of which
factors contribute to heart disease in Indians, it was necessary to do more
than one examination. The second examination was conducted to show whether
these risk factors change with time. In addition, new measurements were added
to increase our understanding of heart disease and lung disease among
American Indians. These were the objectives of the second examination – the
Phase II examination. The
Phase II examination was conducted between 1993 and 1995. It re-examined 89%
of all surviving members of the original cohort. During the examination,
medical history was updated and a 24-hour dietary recall was performed on all
individuals. Alcohol consumption and tobacco use were reassessed. The
physical examination included measures of body fat, body circumferences and
blood pressure, an evaluation of peripheral vascular disease, and a 12-lead
resting electrocardiogram (ECG). Measures of pulmonary function, an
echocardiogram, and a gallbladder sonogram were added. Laboratory
measurements included fasting and post-load glucose, and fasting insulin,
fasting lipids, fibrinogen, PAI1, glycated hemoglobin, and urinary albumin
and creatinine; red blood cell allotypes were also assessed. Blood samples
for future analysis were again stored at -70°.
The Phase III exam was conducted between 1998 and
1999 and 88% of all surviving participants were re-examined. The examination
included personal habits and medical history update, twenty-four hour dietary
recall, and assessment of alcohol and tobacco consumption. The physical exam
included measures of body fat, body circumferences and blood pressure, an
evaluation of peripheral vascular disease, and a 12-lead resting
electrocardiogram. Ultrasound assessment of the carotid arteries and a
measurement of arterial stiffness were added; skin testing and monitoring of
pulmonary function were done in those with a history of asthma. Laboratory
measurements included fasting and post-load glucose, and fasting insulin,
fasting lipids, fibrinogen, PAI1, glycated hemoglobin, and urinary albumin
and creatinine, hematocrit and Chemistry Profile (SMAC 12, including
electrolytes, BUN, creatinine, total protein, SGPT, and SGOT). Additionally, SHS demonstrated in the Phase III
pilot Family Study (May through December 1997) that the study was able to
recruit and retain large kindreds from which physiologic measurements were
made and blood samples taken for direct genotyping.
The Phase IV Exam is a continuation and marked
expansion of the Family Study initiated in Phase III. Phase IV will recruit and
examine 90 more families and perform linkage analysis on a total sample of
3600 individuals including re-examination of the 900 Phase III Family Study
participants. The major components of Phase IV include non-invasive carotid
ultrasound and pressure waveform analysis, measures of LV structures and
function by echocardiography, and laboratory tests (include measures of
Thyroid Stimulating Hormone (TSH) and Endothelin and VCAM-1). The Strong Heart Study-IV (SHS, Cardiovascular
Disease in American Indians Phase IV) is continuing the mortality and
morbidity surveillance of the original cohort, the study of the inheritance
of risk factors in American Indian families, and the re-examination of the
members of the original families recruited in Phase III.
Phase V of SHS will continue to examine the genetic
basis of a wide spectrum of cardiovascular phenotypes to enable quantification
of CVD, to assess trends over time in cardiovascular risk factors and CVD
events, with focus on diabetes,
and to further evaluate the alarming prevalence of diabetes, diabetes-associated risk factors and preclinical CVD
in young American Indians. The Phase V
Exam is a continuation of the Family Study initiated in Phase III and greatly
expanded in Phase IV. In Phase V all
family members examined in Phase III and/or Phase IV will be invited to the
Phase V exam. This re-examination will
incorporate the major components of Phase IV including non-invasive carotid
artery ultrasound and measures of the structure and function of the heart by
echocardiography. These ultrasound
measures will be expanded to include assessment of atherosclerosis in the
legs (popliteal artery in the knee area) as an indicator of peripheral artery
disease. The laboratory tests will
include the usual blood and urine indicators of general and cardiovascular
health and will also include new indicators of inflammation (namely, free
fatty acids (FFA), C-reactive protein (CRP) and leptin), which appear to be
related to obesity, insulin resistance and diabetes, all of which are
important risk factors for CVD. In addition to re-examining the members of
the original families recruited in Phase III and/or Phase IV, the Strong Heart Study-V (SHS, Cardiovascular
Disease in American Indians Phase V) is continuing the mortality and
morbidity surveillance of the original SHS cohort, initiating
annual mortality surveillance and limited morbidity follow-up of the
non-cohort family members, and continuing the study of the
inheritance of risk factors in American Indian families.
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