O1002: Cardiometabolic Risk Profile in Native American Adolescents: The Strong Heart Family Study

Background: Current data demonstrate that life expectancy in the United States (US) is at its lowest level since 1996, partly due to cardiovascular disease (CVD). American Indian (AI) children demonstrate the highest frequency of obesity of any racial group in the US. This study aims to describe baseline cardiometabolic characteristics of AI adolescents enrolled in the Strong Heart Family Study (SHFS) as well as associations of obesity with the development of abnormal left ventricular mass index (LVMI) and ejection fraction (EF) over time.

Methods: SHFS is a longitudinal cohort study of CVD in a large cohort of families from four AI communities in the US. This sample includes adolescents (>14yo) with cardiometabolic data collected at baseline (2001-2003) and again at a 6-year follow-up (2007-2009). Primary outcome variables included abnormal EF and/or LVMI. Covariates included sex, age at baseline, and associated disease processes: hypertension, diabetes mellitus, and cholesterol and triglyceride levels. Body mass index (BMI) category at baseline and follow-up, defined as normal or overweight/obese, was treated as an effect modifier. Chi-square and Fisher’s exact tests evaluated categorical variables, and a Kruskal-Wallis test evaluated continuous variables. Longitudinal trends in baseline and follow-up BMI, EF, and LVMI were analyzed by Wilcoxon signed-rank test for matched pairs. Univariable logistic regression was then performed to evaluate associations of depressed EF and abnormal LVMI by covariates while stratifying by obesity category.

Results: A total of n=384 adolescents and young adults (15-22 years old) participated and had complete data in the SHFS, of which 58% were overweight (n=87) or obese (n=122) at baseline. Baseline cardiometabolic characteristics are delineated in the Table. At baseline, more females than males were overweight and/or obese. Notably, blood pressure, hemoglobin A1C, cholesterol, and triglyceride levels were elevated in the overweight/obese groups despite a median age of only 17.9 years. From baseline to 6-year follow-up, there was a statistically significant increase in BMI and a decrease in EF (Figure). Logistic regression revealed 3.6 times higher odds (95% CI 1.22-10.98), p=0.021) of having depressed EF ( < 54%) among males who were overweight/obese. There were no significant cardiometabolic associations with LVMI.

Conclusion: To the best of our knowledge, this is the first national study to describe comprehensive cardiometabolic data among AI youth, which revealed concerning cardiometabolic profiles and significantly higher odds of decreased EF in obese/overweight AI males. Time trends of increasing BMI and decreasing EF in this cohort are especially troubling. Strategies to promote healthy weight and reduce cardiometabolic risk are warranted in this population. It is imperative to recognize how systemic racism, historical trauma, adverse childhood experiences, and ongoing threats to Indigenous sovereignty have contributed to worse CVD and social determinants of health in AI communities and identify mitigation strategies that optimize outcomes.