|
 
|
About the Strong Heart Study (SHS)
In
the early 1980s, a review of existing data by the Subcommittee on
Cardiovascular and Cerebrovascular Disease of the Secretary of Health and Human Service’s
Task Force on Black and Minority Health
concluded that information on cardiovascular disease (CVD) in American
Indians was inadequate and strongly recommended epidemiologic studies of
this problem. The Strong Heart Study
(SHS) was designed to respond to this recommendation.
Cardiovascular
disease has become the leading cause of death in American Indians. Major problems such as small community
size, relatively young age, cultural diversity, and the geographic
dispersion of the American Indian population have made it difficult to
determine the prevalence and severity of cardiovascular disease among
American Indians.
The
SHS is a study of cardiovascular disease and its risk factors among
American Indian men and women supported by the National Heart, Lung, and Blood
Institute (NHLBI) since October 1, 1988 and is the largest
epidemiologic study of American Indians ever undertaken. The SHS, which uses standardized
methodology, is designed to estimate cardiovascular disease mortality and
morbidity and the prevalence of known and suspected cardiovascular disease
risk factors in American Indians and to assess the significance of these
risk factors in a longitudinal analysis.
The study included 13 American Indian tribes and communities in
three geographic areas: an area near Phoenix,
Arizona, the southwestern area of Oklahoma,
and western and central North and South Dakota.
In
its initial stages, the SHS included three components. The first was a survey to determine
cardiovascular disease mortality rates from 1984 to 1994 among tribal
members aged 35-74 years of age residing in the 3 study areas (the
community mortality study). The
second was the clinical examination of 4,500 eligible tribal members. The third component is the morbidity and
mortality (M&M) surveillance of these 4,500 participants. The SHS has completed three clinical
examinations of the original Cohort (Phase
I: 1989-1991; Phase
II: 1993-1995; Phase
III: 1998-1999, respectively). Due to the importance of genetics in the
occurrence of CVD, the SHS expanded into the genetic epidemiology
area. In the Phase III study, in addition
to the Cohort examination, the study conducted a pilot family study. Each field center recruited about 10
large families. The family pilot
study recruited approximately 30 families which consisted of more than 900
family members. Due to the success
of the pilot study, Phase
IV was funded to conduct a full-blown family study to
investigate the heritability of CVD and its risk factors and to localize
genes that contribute to CVD risk. A
10-centimorgan map has been constructed and linkage analysis is being
performed to assess inheritance of CVD risk factors. In Phase IV, an additional 18 to 25
extended families (a total of about 900 members at least 15 years of age)
were recruited from each of the field centers from 2001 – 2003. This provides a total of 3,776
individuals from 94 families, of whom 825 are Phase III participants
re-examined in Phase IV.
Phase V
of the SHS is pursuing the following aims: 1) Expand the genetic studies
that will emphasize the genome scan approach, but also include
investigation of carefully selected candidate genes. The completed genome scan of 3,776
members from 94 extended families will be used to localize genes that
contribute to CVD susceptibility. We
also will examine a selected number of candidate genes that are difficult
to implicate on the basis of linkage studies, but are of potential
importance to vascular disease. 2)
Continue the mortality and morbidity surveillance of the original cohort
(2859 male and female survivors, ages 60 – 89 years) and to initiate annual
mortality surveillance and limited morbidity follow-up of the non-cohort
family members. 3) Re-examine the family
members so that changes in risk factors can be analyzed and genetic effects
on changes estimated.
Advantages of the SHS include the
following: 1) It provides health
data on an underserved ethnic group.
2) It is the largest, longest longitudinal study in the US of CVD
and its risk factors in individuals with diabetes. 3) Data from cardiac, carotid, and
popliteal ultrasound measures will substantially improve understanding of
mechanisms of vascular disease in diabetes and the genetics of CVD. 4) This population includes a group in
which the epidemic of obesity and diabetes has impacted people at very
young ages, permitting analysis of genetic and environmental effects on
these conditions with limited confounding by age effects. SHS may lead to valuable therapeutic and
prevention strategies for this and other populations in the US and the
world, where the epidemics of obesity, diabetes, and CVD are increasing
rapidly.
|
Contact
the Strong Heart Study:
Center for American Indian Health Research
College of Public Health
University of Oklahoma Health Sciences
Center
P.O. Box 26901
Oklahoma City, OK 73190-0901
(405) 271-3090
Toll Free 1-888-231-4671
|
OUHSC
Links
|
|
Principle Investigators
|
Arizona Center and Core Laboratory
Barbara Howard, Ph. D., MedStar
Research Institute
Dakotas Center
Phase
I-II: Thomas K. Welty, M.D., Aberdeen
Area Indian Health Service
Phase
III: Thomas K. Welty, M.D., Aberdeen Area Tribal Chairmen's Health
Board
Phase
IV: Lyle Best, M. D., Missouri Breaks Industries Research, Inc.
Oklahoma Center and Coordinating Center
Elisa T. Lee, Ph. D., Center for American
Indian Health Research (CAIHR), University
of Oklahoma Health Sciences Center (OUHSC).
ECG and Ultrasound Reading Center
Richard B. Devereux, M. D., Division of Cardiology, the New York Presbyterian Hospital – Weill Medical College of Cornell
Medical Center.
SHS Family Study Center
Jean W. MacCluer, Ph. D., Department of Genetics, Southwest Foundation for Biomedical Research.
 For the full list of Principal and
Co-Investigators and their contact info, please refer to Appendix I in
the SHS
Operations Manual, Volume 1
The organizational chart can be viewed in Appendix
2 of the SHS
Operations Manual, Volume 1.
SHS has the following standing committees:
Steering Committee ( Full list of members can be viewed in Appendix
3 in Volume
1 of the Operations Manual)
Subcommittees: ( Full list of members can be viewed in Appendix
4 in Volume
1 of the Operations Manual)
|
