| Institution: | 1. Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA;2. Weill Cornell Medical College, New York, NY, USA;3. Department of Pediatrics and Medicine, University of Washington, Seattle WA, USA;4. Population Health, Texas Biomedical Research Institute, San Antonio, TX, USA;5. Department of Epidemiology, University of Washington, Seattle, WA, USA;6. MedStar Health Research Institute, Hyattsville, MD, USA;7. Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA;1. Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark;2. Department of Cardiology, Zealand University Hospital, Roskilde, Denmark;3. Novartis Healthcare, Denmark;4. I2minds, Aarhus, Denmark;5. Danish Institute for Health Services Research, Copenhagen, Denmark;1. Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy;2. Radiology Unit, Department of Diagnostic Imaging and Interventional Radiology, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy;3. Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin - Corso Svizzera, 164-10149, Turin, Italy |
| Abstract: | Background and aimsRates of cardiovascular disease (CVD) among American Indians (AI) have been increasing. Although we have observed an association between atherosclerosis and CVD in older adults, the potential association among young AI is unclear. Therefore, we aim to describe the prevalence of atherosclerosis among young AI and determine its association with CVD and all-cause mortality.Methods and resultsWe evaluated AI participants from the Strong Heart Family Study (SHFS), who were <40 years old and CVD free at the baseline examination, 2001–2003 (n = 1376). We used carotid ultrasound to detect baseline atherosclerotic plaque. We identified CVD events and all-cause mortality through 2019, with a median follow-up of 17.8 years. We used shared frailty Cox Proportional Hazards models to assess the association between atherosclerosis and time to CVD event or all-cause mortality, while controlling for covariates.Among 1376 participants, 71 (5.2%) had atherosclerosis at baseline. During follow-up, 120 (8.7%) had CVD events and 104 (7.6%) died from any cause. CVD incidence was higher in participants who had baseline atherosclerosis (13.51/1000 person-years) than in those who did not (4.95/1000 person-years, p = 0.0003). CVD risk and all-cause mortality were higher in participants with atherosclerosis, while controlling for covariates (CVD HR = 1.85, 95%CI = 1.02–3.37, p = 0.0420; all-cause mortality HR = 2.04, 95%CI = 1.07–3.89, p = 0.0291).ConclusionsAmong young AI, atherosclerosis was independently associated with incident CVD and all-cause mortality later in life. Thus, atherosclerosis begins early in life and interventions in adolescents and young adults to slow the progression of disease could prevent or delay CVD events later in life. |
