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Cardiovascular Risk Among Urban Aboriginal People

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Cardiovascular Risk Among Urban Aboriginal People INDIGENOUS HEALTH INDIGENOUS HEALTH Cardiovascular risk among urban Aboriginal people Peter L Thompson, Pamela J Bradshaw, Margherita Veroni and Edward T Wilkes NATIONAL HEALTH STATISTICS reveal ABSTRACT the continuing poor cardiovascular health of Indigenous Australians1. Adult Objective: To describe the results of a program for detecting high cardiovascular risk Aboriginal people have a life expectancy in an urban Aboriginal community. 10–14 years shorter than non-Aborigi- Design: Cardiovascular risk assessment program conducted between January 1998 The Medical Journal of Australia ISSN: nal Australians, primarily due to cardio- and October 1999. Participants completed a questionnaire and underwent a physical 0025-729X 4 August 2003 179 3 143-146 vascular disease. Although the 2001 assessment and biochemical tests. ©The Medical Journal1 of Australia 2003 Nationalwww.mja.com.au Health Survey included data Participants: 738 self-selected members of the Perth Aboriginal community (332 Indigenous Health on self-reported health behaviours in men, 406 women; age range, 18–79 years). Indigenous populations by region, there are no detailed data on the patterns of Results: The participants represented approximately a fifth of the Perth Aboriginal cardiovascular risk in urban Aboriginal population aged 25–64 years (those aged 18–24 years comprised < 5% of Aboriginals populations. aged 15–24 years in Perth). Eighty-four per cent fell within National Heart Foundation The Western Australian Centre for “high risk” or “highest risk” categories for cardiovascular disease; 15% of men and 6% Aboriginal Cardiovascular Health, of women had an absolute risk of a cardiovascular event of over 15% within 10 years. established in 1997 to determine the A high proportion of participants reported diabetes, hypertension, smoking, overweight feasibility of detecting people at high and obesity. A fasting plasma glucose level indicative of diabetes or impaired fasting risk for cardiovascular disease in Perth’s glucose was found in 8.6% (95% CI, 6.2%–11%) of people not previously known to Aboriginal population, undertook the have diabetes. Obesity and smoking were twice as prevalent in study participants as Perth Aboriginal Atherosclerosis Risk in the general population. Less than a third of subjects with hypertension and diabetes Study (PAARS). We report the initial had attained recommended target levels for blood pressure reduction or glycaemic outcomes of the study. control, and only a third of those at high risk and one in six of those at highest risk had attained recommended lipid-level targets. Conclusions: A cardiovascular risk assessment program with strong community METHODS support in an urban Aboriginal population can identify a significant number of people with high cardiovascular risk who are candidates for intensive risk-factor reduction Community consultation strategies. Discussions were held with the Perth Aboriginal community and the Board of MJA 2003; 179: 143–146 Management of the Derbarl Yerrigan Health Service (the Perth Aboriginal Medical Service). A memorandum of National Health and Medical Research owners of the region. People identifying understanding covered the conduct of Council guidelines for research studies themselves as Aboriginal were recruited the study, aspects related to respect for in Aboriginal and Torres Strait Island- through health, educational, public serv- Aboriginal and Nyoongar culture, and ers.2 The Committee for Human Rights ice and community institutions, and by confidentiality of results. at the University of Western Australia family and community contact. (As race approved the study. is not noted on the electoral rolls, ran- Informed consent and ethical approval dom sampling was not possible.) Public- ity for the study was generated through Each participant provided written Participants and recruitment the Derbarl Yerrigan Health Service, informed consent. The form was devel- Participants were recruited in the Perth workplaces, community organisations, oped in consultation with Aboriginal metropolitan area, the majority being and word of mouth. Community leaders community members and followed Nyoongar people, the traditional land and sporting figures endorsed the cam- paign, and Aboriginal community radio Western Australian Heart Research Institute, Sir Charles Gairdner Hospital, and newsletters were used to encourage Nedlands, WA. recruitment to the study. Peter L Thompson, MD, FRACP, Cardiologist; and Clinical Professor, School of Medicine and Pharmacology, and School of Population Health, University of Western Australia, Perth; The study was conducted between Pamela J Bradshaw, RN, MSc, Clinical Research Coordinator; January 1998 and October 1999. Margherita Veroni, MSc, Epidemiologist. Derbarl Yerrigan Health Service (Perth Aboriginal Medical Service), East Perth, WA. Questionnaire Edward T Wilkes, BA, Director. Reprints: Professor Peter L Thompson, Western Australian Heart Research Institute, 1st Floor, C Block, Participants completed a questionnaire Sir Charles Gairdner Hospital, Nedlands, WA 6009. [email protected] modified from the Australian National MJA Vol 179 4 August 2003 143 INDIGENOUS HEALTH Heart Foundation (NHF) 1989 Risk ■ Risk of coronary heart disease: total 3 у 1: Self-reported cardiovascular Factor Prevalence Survey. The ques- cholesterol (TC) level 5.5 mmol/L history and cardiovascular risk tionnaire was self-completed or admin- (“increased risk”); TC level factors in men (n = 332) and 4 istered by an Aboriginal healthcare у 6.5 mmol/L (“very high risk”); NHF women (n = 406) worker, according to the subject’s pref- target treatment level, р 4.0 mmol/L.10 erence. Medical history or cardiovascular Number of Number of Comparisons with national health data risk factor men (%) women (%) Physical assessment and biochemical The Australian Institute of Health and Angina 32 (10%) 28 (7%) tests Welfare’s Cardiovascular risk factors AMI 16 (5%) 17 (4%) 11 Health assessments were conducted at report (hypertension and smoking) CVA (stroke) 6 (2%) 6 (1.5%) Derbarl Yerrigan Health Service, com- and the 1999 Heart, stroke and vascular Hypertension 90 (27%) 107 (26%) munity centres and the Gairdner Cam- diseases report12 (BMI and TC) were Diabetes 53 (16%) 77 (19%) pus of the Western Australian Heart used for comparing the PAARS results with statistics for the Australian popula- High total 61 (18%) 56 (14%) Research Institute. cholesterol level Subjects were weighed in light cloth- tion as a whole. Current smoker 152 (46%) 179 (44%) ing without shoes, and height was meas- ured against a stadiometer. Girth at the Family history of 141 (43%) 208 (52%) CVD waist and hips were measured at stand- RESULTS ard anatomical points. The mean of two AMI = acute myocardial infarction. There were 738 study participants (332 CVA = cerebrovascular accident. blood pressure (BP) readings, measured CVD = cardiovascular disease. men, 406 women); those aged 25–64 on the right arm after subjects had been years represented about a fifth of the seated for 5 minutes, was recorded. Perth Aboriginal population (deter- Body mass index (BMI) and waist/hip diabetes and 40% with a history of mined from 1996 census data) in that hypertension were smokers). ratio were calculated. Cardiovascular age group. The younger participants risk categories were determined using Physical examination. An excessive 4 (18–24 years) comprised < 5% of 15– waist circumference was found in 32% both NHF criteria and Sheffield 24-year-old Aboriginals in Perth (the tables.5 (95% CI, 29%–34%) of men and 61% census counted those aged 15–24 (95% CI, 59%–63%) of women. An Plasma lipid and glucose levels were years). The median age for men was 37 measured on fasting venous blood excessive waist/hip ratio was present in years (range, 18–65 years) and for 60% (95% CI, 57%–63%) of men and samples. women, 38 years (range, 18–79 years). A written assessment of cardiovascu- 43% (95% CI, 41%–45%) of women. The proportion of study participants Comparisons of our data with Austral- lar risk was sent to each of the particip- who were employed was significantly ants (and, with their agreement, to their ian population data for hypertension, higher than the proportion in the Perth overweight, smoking and hypercholes- general practitioner), giving recommen- Aboriginal population as a whole. In the terolaemia are summarised in Box 2. dations for further action if needed. age groups 25–64 years in the PAARS Lipids. Mean total cholesterol levels sample, 170/209 (81.3%) men were were 5.5 mmol/L (95% CI, 5.4– Definitions employed, versus 1398/1912 (73.1%) 5.6 mmol/L) in men and 5.2 mmol/L men in the Perth Aboriginal population, The definitions adopted in assessing (95% CI, 5.1–5.3 mmol/L) in women. a difference of 8.2 percentage points cardiovascular risk were as follows: In 50% of men and 36% of women, TC (95% CI, 2.5–14). Of the women in the у ■ у level was 5.5 mmol/L, and in 19% of Hypertension: systolic BP 140 mmHg PAARS sample, 195/215 (90.7%) were and/or diastolic BP у 90mmHg, or men and 11% of women TC level was employed compared with 1172/1403 у 6.5 mmol/L. subject currently receiving treatment for (83.5%) in the Perth Aboriginal popula- hypertension;6 The mean high-density lipoprotein tion, a difference of 7.2 percentage (HDL) cholesterol level (for men and ■ Overweight and obesity: BMI у 25 kg/ points (95% CI, 3–11). women combined) was 1.11 mmol/L m2 and BMI у 30 kg/m2, respectively.7 Self-reported risk factors. The numbers (95% CI, 1.18–1.22 mmol/L), the mean ■ Excessive waist circumference: у 88 cm of men and women with a past history low-density lipoprotein (LDL) choles- у (women), 102 cm (men); of cardiovascular disease and self- terol level was 3.3 mmol/L (95% CI, у ■ Excessive waist/hip ratio: 0.88 reported risk factors are shown in Box 3.22–3.36 mmol/L), and the mean у 8 (women), 0.95 (men); 1. serum triglyceride level was 2.05 mmol/ ■ Current smoker: anyone currently Overall, 46% of men and 44% of L (95% CI, 1.91–2.12 mmol/L).
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