AHA Seeks to Address Health Disparities in American Indians, Alaska Natives

Khadijah Breathett, MD

The latest scientific statement from the American Heart Association (AHA) is seeking to bring greater attention to the disparities in cardiovascular health and care among Alaska Natives and American Indians.

Written on behalf of the AHA’s Council on Epidemiology and Prevention and other groups, the statement outlines disproportionately high rates of cardiovascular disease and other challenges faced by these patients as a result of historic injustice and present-day bias.

“There are urgent cardiovascular health risks for American Indians and Alaska Natives that health care professionals and policy makers should not ignore. We strongly encourage patients, health care professionals and most importantly, community leaders to take steps to prevent and fight cardiovascular disease,” said Khadijah Breathett, MD, MS, chair of the writing committee, assistant professor of medicine in the division of cardiology at the University of Arizona, and advanced heart failure and transplant cardiologist at Banner—University Medical Center in Tucson, Arizona, in a statement.

With these populations experiencing 3 times the rate of cardiovascular disease of white Americans and both populations growing in recent years, Breathett and a team of colleagues sought to provide the general public and those in the medical community an overview of the challenges faced by Alaska Natives and American Indians in regard to cardiovascular health. Including nearly 100 references, the 12-page document details multiple risk factors, management approaches, and social determinants of health unique to these patients.

After providing historical context and demographic information, the first issue addressed by investigators is the risk factors for cardiovascular disease—broken down into 3 subsections for clinical, behavioral, and demographic and genetic risk factors, respectively.

With data indicating a 3-fold greater prevalence of diabetes mellitus in American Indians versus white patients, the authors emphasized the importance of diabetes management as part of reducing cardiovascular risk. Other risk factors highlighted include disparities in obesity, renal function, cholesterol management, and tobacco use in these populations.

Following the portion on risk factors, Breathett and colleagues highlight social determinants of health brought on by social injustice throughout history, including lower educational attainment, wealth inequality, and lack of health insurance. In 2017, 19.3% of American Indians and Alaska Natives reported not having health insurance and, in that same year, 21% of this population lived below the poverty line.

Also included in the section on social determinants is the potential for increased exposure to toxic metals due to groundwater contamination, which authors noted is more common in the Midwest and Southwest.

“Racial and ethnic minority groups in the U.S. have suffered from inequitable policies for hundreds of years. These policies have contributed to mistrust in the traditional health care system. The most effective way to create change is through restructuring of inequitable policies and empowerment of communities,” said Breathett, in the aforementioned statement.

The last major section of the document prior to the conclusion addressed management approaches for these patients. In this section, authors highlighted the importance of aggressive risk factor control and the benefit of community-based programs implemented to improve cardiometabolic health in these patients.

Additionally, this section emphasized the benefit of shared decision making can have in Alaska Natives and American Indian populations and the detrimental impact of physical bias—calling for implicit bias training to reduce risk and improve care.

“We encourage patients, healthcare professionals and community stakeholders to learn the risk factors for cardiovascular disease and take steps to fight cardiovascular disease before it starts. We are all in this together,” said Breathett.

This scientific statement, titled “Cardiovascular Health in American Indians and Alaska Natives,” was published in Circulation.