All-cause and CVD mortality in Native Hawaiians

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Abstract

Aims

Cardiovascular disease (CVD) is the leading cause of death among Native Hawaiians. In this article, all-cause and cardiovascular mortality rates among Native Hawaiians are examined, along with associated CVD risk factors.

Methods

A total of 855 Native Hawaiians (343 men and 512 women, ages 19–88) were examined as participants of the Cardiovascular Risk Clinics program (1992–1998) and underwent surveillance through September 2007. Cause of each death was determined by review of medical records, death certificates, newspapers, and through queries to community members.

Results

CVD accounted for 55% of deaths. Coronary heart disease (CHD) accounted for the majority of CVD deaths. CVD increased with age and was higher in those with diabetes, hypertension, or high low-density lipoprotein cholesterol (LDL-C). CVD rates were higher in men than in women and fourfold higher in those with diabetes. In addition to age, diabetes, hypertension, and elevated LDL-C were major risk factors.

Conclusions

Diabetes is a major determinant of CVD in this population and most of the CVD is occurring in those with diabetes. Strategies to prevent diabetes and manage blood pressure and lipids should reduce CVD rates in Native Hawaiians.

Introduction

Cardiovascular disease (CVD) is the leading cause of death among Native Hawaiians [1], [2], but data to date have been obtained from state health records that are based solely on death certificates. The only systematic population-based study of Native Hawaiian adults, the Native Hawaiian Health Research Project, did not examine mortality records to determine cause of death [3]. More information can be obtained by reviewing cause of death in medical records, where standardized methods allow for comparisons with other populations [4], [5], [6], [7]. This analysis was conducted to provide systematic data on CVD mortality in Native Hawaiians and to examine the roles of potential CVD risk factors.

From 1992 to 1998, the Cardiovascular Risk Clinic (CRC) program on the island of Moloka‘i examined a population-based sample of Native Hawaiians [8]. Information on physiologic and lifestyle risk factors was obtained using systematic methods, and all deaths in this population since the beginning of the CRC program have been reviewed, with cause of death adjudicated using standardized criteria. In this article, the data on all-cause and cardiovascular mortality rates in this population, along with associated CVD risk factors, will be presented.

Section snippets

Subjects

The CRC was a screening program initiated in 1992 and implemented by Na Pu‘uwai, the Native Hawaiian Health Care System serving the island of Moloka‘i, to identify adults at risk for CVD and refer them to health care services [9]. Native Hawaiian male and non-pregnant female residents ≥age 18 were recruited for participation. Recruitment strategies involved mailings and direct contact by community health workers. The CRCs were conducted in the main town and also in rural areas to accommodate

Examination

The baseline examination consisted of a questionnaire evaluating behavioral risk factors, including smoking, alcohol use, physical activity, and diet. Measurements of height, weight, waist and hip circumference, and blood pressure (BP) were made by trained observers. A morning urine specimen was obtained for protein and glucose, and a fasting blood sample was obtained for cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C),

Results

Characteristics of the study population are shown in Table 1. Average age was 46, and 46.2% were obese with central fat distribution. BP and lipid values varied widely. Average age and BMI in men and women were similar, but men had slightly higher BP, lower HDL-C, and were more likely to smoke. Diabetes prevalence was 23.3% in men and 20.3% in women; average duration (self-reported) was approximately 8 years.

Cause-specific mortality rates are shown in Table 2. The CVD mortality/1000

Discussion

This longitudinal analysis in a population-based cohort was undertaken to provide systematic data on CVD mortality in Native Hawaiians and to examine the roles of potential CVD risk factors. CVD was the largest cause of mortality in this population, accounting for 56% of deaths in men and 54% in women; cancer accounted for only 10%. CVD rates were higher in men than in women, and the majority of CVD deaths were due to MI and CHD. In addition to age and gender, diabetes, hypertension, and

Conflicts of interest

Dr. B.V. Howard has served on the advisory boards of Merck, Schering Plough, and the Egg Nutrition Council and has received research support from Merck and Pfizer. Dr. Wm. J. Howard has received research support from Pfizer, AstraZeneca, Merck, and Schering-Plough; has served as a consultant for Merck, Schering-Plough, Pfizer, and Reliant; and has served on the Speakers’ Bureaus for Merck, Schering-Plough, Pfizer, AstraZeneca, Abbott, and Daiichi Sankyo. Dr. M.K. Mau has served as a consultant

Acknowledgments

The authors gratefully acknowledge the Moloka‘i community; Hua Kanawao Ka Liko's Community Council; Na Pu‘uwai Native Hawaiian Health Care System; Queen Lili‘uokalani Children's Center-Moloka‘i Unit; and Papa Ola Lōkahi for their commitment to CVD research that adhered to community-based participatory research principles. We thank Rachel Schaperow, MedStar Health Research Institute, for editing the manuscript. The contents of this article are solely the responsibility of the authors and do not

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    This work was supported by grants [P20 MD 000173, P20 MD00174] from the National Center for Minority Health and Health Disparities (NCMHD), National Institutes of Health (NIH). This study was also supported in part by the Myron Pinky Thompson Endowed Chair [S21 MD000228], a grant from the National Heart, Lung and Blood Institute [U01 HL079163], and by the Department of Native Hawaiian Health, John A. Burns School of Medicine. An abstract of this data was presented at the American Heart Association Epi/NPAM Meeting, Palm Harbor, FL, March 2009.

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