Every February, campaigns for American Heart Month remind us that cardiovascular disease (CVD) is the leading cause of death in the U.S. So you probably won’t be surprised to hear that holds true among Native Americans. But as with many healthcare conditions, heart health is worse in Tribal nations – with CVD mortality rates 20% higher among Native Americans.

Death comes earlier too; 36% of CVD deaths occur before age 65 for Native patients, compared to 14.7% for White patients with CVD. Heart disease deaths are 30% higher for Alaska Native people age 25 to 44 – and 40% higher for patients age 45 to 54.

Heart Health Risk Factors

Cardiovascular disease is an umbrella term that covers every type of disease affecting the heart or blood vessels – including coronary heart disease. Factors influencing heart health for Native Americans include:

• Stress. Historical trauma, discrimination, racism, and other stressors can affect heart health. Native American poverty rates are at 26.2 percent, nearly double that of the rest of the United States.
• Sex. Native men have higher ratesof CVD than women, according to the Strong Heart Study, which explored cardiovascular disease in Native Americans.
• Genetics. The Strong study also found that heritability pattern contributes to 20% to 50% of the phenotype of CVD risk factors such as obesity, dyslipidemia, hypertension, and diabetes mellitus.
• Clinical discrimination. 23% of Native patients reported experiencing discrimination in clinical settings; 15% have avoided seeking care for themselves or family members due to anticipated discrimination.
• Environmental poisoning. Nuclear testing, high levels of air pollution, and exposure to toxic metals in Tribal nations is linked to a dramatic increase in cancer, heart disease, and stroke.
• Food Insecurity. 1 in 4 Native Americans is food insecure.  A new study suggests that food insecurity is linked to cardiovascular disease.
• Diabetes. Diabetes mellitus is a strong risk factor, with rates approaching 24% in Native Americans – that’s compared to 8% in White patients. The Strong study found almost all women and more than half the men with diabetes had heart disease.
• Hypertension. High blood pressure is strongly linked to CVD risk, with one study finding Native adults were 10% more likely than White adults to have high blood pressure.
• Smoking. Native Americans cigarette use is nearly double that of White and Black smokers, according to the 2016 National Health Interview Survey from the Centers for Disease Control and Prevention (CDC).
• Obesity. The obesity epidemic is rampant across all U.S. populations, but Native communities are leading the rest – with obesity rates than span 30% to 40%.

The good news is that healthcare teams have the power to radically reduce cardiovascular disease rates.

Telemedicine Access

Underfunded Indian Health Service facilities may not always offer cardiology services beyond echocardiography and treadmill testing. While some services must be done in person, such as coronary bypass, telemedicine can connect patients to a cardiologist’s care and help them avoid traveling hours for a 25-minute appointment.

Smoking Cessation Programs

An estimated 56% of Native smokers report the desire to quit smoking. The problem: Native people can have a harder time accessing a commercial tobacco cessation service. When they do, that program may not differentiate between ceremonial tobacco use and recreational smoking. What’s needed are culturally adapted programs that involve Tribal leadership. Young leaders can be especially effective in stopping smoking in the younger generation.

Diabetes and Hypertension Management

Several programs tailored to Native communities have had great success in addressing risk factors. The Special Diabetes Program for Indians offers a Healthy Heart program and a Diabetes Prevention Program; the Native-CHART project (Native-Controlling Hypertension and Risk Through Technology) works to help Native patients lower their blood pressure and reduce their risk of stroke. The REACH program (Racial and Ethnic Approaches to Community Health), developed by the CDC, blends community empowerment, cultural intelligence, and clinical treatment.

Cultural Approaches

Sweat lodge ceremonies, talking circles, and community-driven programs are effective ways to help Native CVD patients learn more about their condition and make lifestyle changes, such as increasing physical activity. Shared decision making is an old Native tradition, which often use community-talking circles that allow each person to provide uninterrupted perspectives and frame health decisions in a cultural context. 

Smarter Practices, Healthier Hearts

Social determinants of health and historical trauma can’t be eliminated overnight – but building culturally relevant practices for all ages and backgrounds is a great start to reducing health inequities. Cardiovascular disease is a community problem, and it takes community-based interventions to change the roots of cardiac disease.