Indigenous Population – ABC CARDIOL

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Original Article

Echocardiography and Analysis of Subclinical Cardiovascular Diseases in Indigenous People Living in Different Degrees of Urbanization: Project of Atherosclerosis Among Indigenous Populations (Pai)

Pedro Vinícius Amorim de Medeiros Patriota et al. Ana Marice T. Ladeia Juracy Marques Ricardo Khoury … Aldina Barral Alvaro A. Cruz Luis Claudio L. Correia Manoel Barral-Netto Joao A. C. Lima Anderson C. Armstrong

Abstract

Background

The urbanization process impacts the burden of cardiovascular disease (CVD). Indigenous populations can undergo a devastating epidemiological transition.

Objective

The present study aimed to describe the Project of Atherosclerosis among Indigenous Populations (PAI) study protocol for assessing echocardiographic images and subclinical CVD in indigenous populations according to the degree of urbanization and report its preliminary results.

Methods

The PAI is a cross-sectional study that includes volunteers aged 30–70 years among Brazilian indigenous groups exposed to low and advanced stages of urbanization (Fulni-ô and Truká, respectively) and an urban control group. Individuals with known CVD or who were on hemodialysis were excluded. The pilot study began in Fulni-ô territory in September 2016. The participants underwent clinical and laboratory evaluations, electrocardiography, carotid artery ultrasound, and a comprehensive echocardiography protocol including global longitudinal strain (GLS) assessed by speckle tracking. The preliminary results are described by participant sex in univariate analysis.

Results

The pilot study evaluated the protocol used in 55 Fulni-ô individuals (mean age, 48.7 ± 12.0 years; 80% women). Traditional risk factors such as hypertension, diabetes, and dyslipidemia were found in 40%, 36%, and 54% of participants, respectively, without significant statistical differences between the sexes. Tobacco use was extremely prevalent, reported in 91% of participants. Most echocardiographic parameters were within the normal range; however, mean GLS was 17.3 ± 3.4% (p = 0.73 between sexes).

Conclusion

We described the PAI study protocol for assessing subclinical CVD and risk factors in indigenous populations by urbanization stage. Its preliminary results suggest a high prevalence of these factors in the indigenous population exposed to a lower degree of urbanization.

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Original Article

Cardiovascular Risk in Xavante Indigenous Population

Luana Padua Soares et al. Amaury Lelis Dal Fabbro Anderson Soares Silva Daniela Saes Sartorelli … Luciana Ferreira Franco Patrícia Chamadoira Kuhn Regina Santiago Moises João Paulo Botelho Vieira-Filho Laércio Joel Franco

Abstract

Background:

The prevalence of cardiovascular risk factors is little known in Brazilian indigenous populations. In the last two decades, important changes have occurred in the lifestyle and epidemiological profile of the Xavante people.

Objective:

to assess the prevalence of cardiovascular risk factors in Xavante adults in São Marcos and Sangradouro/Volta Grande reserves, in the state of Mato Grosso, Brazil.

Methods:

Cross-sectional study carried out with 925 Xavante people aged ≥ 20 years between 2008 and 2012. The following indicators were assessed: triglycerides (TG), total, LDL and HDL-cholesterol, Castelli index I and II, TG/HDL-cholesterol ratio, apo B / Apo A1 ratio, Framingham risk score, C-reactive protein, body mass index (BMI), waist circumference (WC), hypertriglyceridemic waist (HW), glycemia and blood pressure. Kolmogorov-Smirnov, Student’s t test and Chi-square test (χ²) were used for statistical analysis, and significance level was set at 5%.

Results:

High prevalence of elevated cardiovascular risk was observed in men and women according to HDL-cholesterol (66.2% and 86.2%, respectively), TG (53.2% and 51.5%), TG/HDL-cholesterol ratio (60.0% and 49.1%), C-reactive protein (44.1% and 48.1%), BMI (81.3% and 81.7%), WC (59.1% and 96.2%), HW (38.0% and 50,6%) and glycemia (46.8% and 70.2%). Individuals aged 40 to 59 years had the highest cardiovascular risk.

Conclusions:

The Xavante have a high cardiovascular risk according to several indicators evaluated. The present analysis of cardiovascular risk factors provides support for the development of preventive measures and early treatment, in attempt to minimize the impact of cardiovascular diseases on this population.

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Editorial

Cardiovascular Diseases in Indigenous Populations: An Indicator Of Inequality

Airton Tetelbom Stein

The number of articles on cardiovascular diseases in indigenous populations is not sufficient as a basis for the development of health policies. Although the most common conditions reported among indigenous people have been infectious and contagious diseases such as malaria, tuberculosis, respiratory infections, hepatitis, sexually transmitted diseases, among others, the prevalence of noncommunicable diseases (NCDs) have increased in this population as a result of urbanization process and their lifestyle. In addition, approaches of these conditions in indigenous people face logistic issues, as they require continuous medical care and development of health promotion programs in difficult areas.

The original, well-conducted study by Armstrong and colleagues contributes to fill this knowledge gap, as it highlights the impact of public investments that not only promote the development of the country, but also reveals the vulnerability and adverse effects of the changes in the lifestyle of indigenous people. Despite its methodological limitations, the study shows an association between mortality for cardiovascular diseases and rapid urbanization in this population.

[…]

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Original Article

Urbanization is Associated with Increased Trends in Cardiovascular Mortality Among Indigenous Populations: the PAI Study

Anderson da Costa Armstrong et al. Ana Marice Teixeira Ladeia Juracy Marques Dinani Matoso Fialho de Oliveira Armstrong … Antonio Marconi Leandro da Silva Jeová Cordeiro de Morais Junior Aldina Barral Luis Claudio Lemos Correia Manoel Barral-Netto João A. C. Lima

Abstract

Background:

The cardiovascular risk burden among diverse indigenous populations is not totally known and may be influenced by lifestyle changes related to the urbanization process.

Objectives:

To investigate the cardiovascular (CV) mortality profile of indigenous populations during a rapid urbanization process largely influenced by governmental infrastructure interventions in Northeast Brazil.

Methods:

We assessed the mortality of indigenous populations (≥ 30 y/o) from 2007 to 2011 in Northeast Brazil (Bahia and Pernambuco states). Cardiovascular mortality was considered if the cause of death was in the ICD-10 CV disease group or if registered as sudden death. The indigenous populations were then divided into two groups according to the degree of urbanization based on anthropological criteria:^, Group 1 – less urbanized tribes (Funi-ô, Pankararu, Kiriri, and Pankararé); and Group 2 – more urbanized tribes (Tuxá, Truká, and Tumbalalá). Mortality rates of highly urbanized cities (Petrolina and Juazeiro) in the proximity of indigenous areas were also evaluated. The analysis explored trends in the percentage of CV mortality for each studied population. Statistical significance was established for p value < 0.05.

Results:

There were 1,333 indigenous deaths in tribes of Bahia and Pernambuco (2007-2011): 281 in Group 1 (1.8% of the 2012 group population) and 73 in Group 2 (3.7% of the 2012 group population), CV mortality of 24% and 37%, respectively (p = 0.02). In 2007-2009, there were 133 deaths in Group 1 and 44 in Group 2, CV mortality of 23% and 34%, respectively. In 2009-2010, there were 148 deaths in Group 1 and 29 in Group 2, CV mortality of 25% and 41%, respectively.

Conclusions:

Urbanization appears to influence increases in CV mortality of indigenous peoples living in traditional tribes. Lifestyle and environmental changes due to urbanization added to suboptimal health care may increase CV risk in this population.

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Echocardiography and Analysis of Subclinical Cardiovascular Diseases in Indigenous People Living in Different Degrees of Urbanization: Project of Atherosclerosis Among Indigenous Populations (Pai)

Abstract

Background

Objective

Methods

Results

Conclusion

Cardiovascular Risk in Xavante Indigenous Population

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

Cardiovascular Diseases in Indigenous Populations: An Indicator Of Inequality

Urbanization is Associated with Increased Trends in Cardiovascular Mortality Among Indigenous Populations: the PAI Study

Abstract

Background:

Objectives:

Methods:

Results:

Conclusions:

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