PAGE: CALiCo: Strong Heart Study (SHS)

The SHS is a study of cardiovascular disease and its risk factors among American Indian men and women. Using standardized methodology, it was designed to estimate cardiovascular disease mortality and morbidity and the prevalence of known and suspected cardiovascular disease risk factors 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. 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 tribal members aged 45-74. The SHS has completed three clinical examinations of the original Cohort (Phase I: 1989-1991; Phase II: 1993-1995; Phase III: 1998- 1999, respectively). The third component is the morbidity and mortality (M&M) surveillance of these 4,500 participants. Yearly SHS surveillance has only 0.2% loss to follow-up. All deaths and all nonfatal CVD events are classified by standardized criteria, including details of stroke and HF. The Strong Heart Family Study (SHFS) is a genetic epidemiological study designed to investigate the heritability of CVD and its risk factors and to localize genes that contribute to CVD risk in American Indians. SHFS participants include 3,838 family members that were >/=15 years old, and ascertained through sibships of the original SHS, from 94 extended (large, multigenerational) families. Exams have occurred in a pilot Phase III (1998-1999, 900 SHFS participants), in Phase IV (2001-2003), and Phase V (2006-2009). SHFS morbidity and mortality surveillance has occurred throughout the study phases, with 0.3% lost to follow-up. Genetic data includes complete pedigree information, DNA samples from all family members, a 10cM-spaced microsatellite map used for IBD estimation and to perform linkage analysis, genotypes for more than 12,000 SNPs in candidate regions, and genotypes from commercially available SNP assays. ]]>
The Strong Heart Study was established to investigate the prevalence, severity of, and risk factors for cardiovascular disease among American Indians. The Strong Heart Study consists of 1) a cohort population of 4,500 American Indian men and women recruited from centers in three geographic regions: Arizona, Oklahoma and North and South Dakota with 3 clinic visits and ongoing Mortality and Morbidity surveillance (Phase I: 1989-1991; Phase II: 1993-1995; Phase III: 1998-1999, respectively), and 2) a multigenerational family genetic study examined in Phase IV (2001-2003) and Phase V (2005-2008) recruited from the same centers and including 3,838 individuals from 94 families, of whom 825 are Phase III participants re-examined in Phase IV. The data for this analysis were from (1) above from the Arizona recruitment site.The Strong Heart Study was established to investigate the prevalence, severity of, and risk factors for cardiovascular disease among American Indians. The Strong Heart Study consists of 1) a cohort population of 4,500 American Indian men and women recruited from centers in three geographic regions: Arizona, Oklahoma and North and South Dakota with 3 clinic visits and ongoing Mortality and Morbidity surveillance (Phase I: 1989-1991; Phase II: 1993-1995; Phase III: 1998-1999, respectively), and 2) a multigenerational family genetic study examined in Phase IV (2001-2003) and Phase V (2005-2008) recruited from the same centers and including 3,838 individuals from 94 families, of whom 825 are Phase III participants re-examined in Phase IV. The data for this analysis were from (1) above from the Arizona recruitment site.For the SHS clinical examinations, all age-eligible tribal members from each center (Arizona, North and South Dakota, and Oklahoma) were invited to participate, with a maximum recruitment at each center of 1,500. Sibships from the original SHS cohort participants were used to identify and invite all age-eligible tribal family members, including all first, second and third degree relatives, to participate in the SHFS. More than 1,200 family members from each center (Arizona, North and South Dakota, and Oklahoma) were recruited. ]]>
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. Major problems such as small community size, relatively young age, cultural diversity, and the geographic dispersion of the American Indian population made it difficult to determine the prevalence and severity of cardiovascular disease among American Indians. The Strong Heart Study (SHS) was designed to respond to this recommendation. Supported by the National Heart, Lung, and Blood Institute (NHLBI) beginning in October 1, 1988, it is the largest epidemiologic study of American Indians ever undertaken. The study included 13 American Indian tribes and communities in three centers in the following geographic areas: an area near Phoenix, Arizona, the southwestern area of Oklahoma, and western and central North and South Dakota. Because of the SHS, we now know that Cardiovascular disease has become the leading cause of death in American Indians. Due to the importance of genetics in the occurrence of CVD, the SHS expanded to include a genetic family study. The Strong Heart Family Study (SHFS) is a genetic-epidemiological study arising from its parent study, the Strong Heart Study (SHS). The SHFS began as a pilot feasibility study during SHS Phase III (1998-1999), where approximately 30 families (10 from each center) with more than 900 family members, were recruited. The SHFS was fully established as a genetic study in Phase IV with a goal of investigating the heritability of CVD and its risk factors and to localize genes that contribute to CVD risk. Advantages of the SHS include the following: 1) It provides health and genetic 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 the mechanisms of vascular disease in diabetes and the genetics of CVD. 4) The epidemic of obesity and diabetes in this population group 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. ]]>