000			03825nam a22005417a 4500
008			191119s20192019 xxu||||| |||| 00| 0 eng d
022			_a2047-9980
024			_a10.1161/JAHA.119.012289 [doi]
040			_aOvid MEDLINE(R)
099			_a31648583
245			_aTrends in Cardiovascular Disease Morbidity and Mortality in American Indians Over 25 Years: The Strong Heart Study.
251			_aJournal of the American Heart Association. 8(21):e012289, 2019 11 05.
252			_aJ Am Heart Assoc. 8(21):e012289, 2019 11 05.
252			_zJ Am Heart Assoc. 8(21):e012289, 2019 Nov 05.
253			_aJournal of the American Heart Association
260			_c2019
260			_fFY2020
265			_sppublish
265			_sppublish
266			_d2019-11-19
268			_aJournal of the American Heart Association. 8(21):e012289, 2019 Nov 05.
520			_aBackground American Indians experience high rates of cardiovascular disease. We evaluated whether cardiovascular disease incidence, mortality, and prevalence changed over 25 years among American Indians aged 30 to 85. Methods and Results The SHS (Strong Heart Study) and SHFS (Strong Heart Family Study) are prospective studies of cardiovascular disease in American Indians. Participants enrolled in 1989 to 1990 or 2000 to 2003 with birth years from 1915 to 1984 were followed for cardiovascular disease events through 2013. We used Poisson regression to analyze data for 5627 individuals aged 30 to 85 years during follow-up. Outcomes reflect change in age-specific cardiovascular disease incidence, mortality, and prevalence, stratified by sex. To illustrate generational change, 5-year relative risk compared most recent birth years for ages 45, 55, 65, and 75 to same-aged counterparts born 1 generation (23-25 years) earlier. At all ages, cardiovascular disease incidence was lower for people with more recent birth years. Cardiovascular disease mortality declined consistently among men, while prevalence declined among women. Generational comparisons were similar for women aged 45 to 75 (relative risk, 0.39-0.46), but among men magnitudes strengthened from age 45 to 75 (relative risk, 0.91-0.39). For cardiovascular disease mortality, risk was lower in the most recent versus the earliest birth years for women (relative risk, 0.56-0.83) and men (relative risk, 0.40-0.54), but results for women were inconclusive. Conclusions Cardiovascular disease incidence declined over a generation in an American Indian cohort. Mortality declined more for men, while prevalence declined more for women. These trends might reflect more improvement in case survival among men compared with women.
546			_aEnglish
650			_a*Cardiovascular Diseases/ep [Epidemiology]
650			_a*Indians, North American/sn [Statistics & Numerical Data]
650			_aAdult
650			_aAged
650			_aAged, 80 and over
650			_aCardiovascular Diseases/mo [Mortality]
650			_aFemale
650			_aHumans
650			_aIncidence
650			_aMale
650			_aMiddle Aged
650			_aMorbidity
650			_aPrevalence
650			_aProspective Studies
650			_aTime Factors
650			_aUnited States/ep [Epidemiology]
651			_aMedStar Health Research Institute
657			_aJournal Article
700			_aCalhoun, Darren
700			_aHoward, Barbara V
790			_aBest LG, Calhoun D, Devereux RB, Howard BV, Jolly SE, Lee ET, MacLehose RF, Muller CJ, Noonan CJ, Stoner JA
856			_uhttps://dx.doi.org/10.1161/JAHA.119.012289 _zhttps://dx.doi.org/10.1161/JAHA.119.012289 _zhttps://dx.doi.org/10.1161/JAHA.119.012289
856			_uhttps://dx.doi.org/10.1161/JAHA.119.012289 _zhttps://dx.doi.org/10.1161/JAHA.119.012289 _zhttps://dx.doi.org/10.1161/JAHA.119.012289
942			_cART _dArticle
999			_c4752 _d4752