ABSTRACT
OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of mortality in New Zealand with a disproportionate burden of disease in the Maori population. The Hauora Manawa Project investigated the prevalence of cardiovascular risk factors and CVD in randomly selected Maori and non-Maori participants. This paper reports the prevalence of structural changes in the heart. METHODS: A total of 252 rural Maori, 243 urban Maori; and 256 urban non-Maori underwent echocardiography to assess cardiac structure and function. Multivariable logistic regression was used to determine variables associated with heart size. RESULTS: Left ventricular (LV) mass measurements were largest in the rural Maori cohort (183.5,sd 61.4), intermediate in the urban Maori cohort (169.7,sd 57.1) and smallest in the non-Maori cohort (152.6,sd 46.7; p<0.001). Similar patterns were observed for other measurements and indexation had no impact. One-third (32.3%) met the gender-based ASE criteria for LV hypertrophy (LVH) with higher prevalence in both Maori cohorts (highest in the rural cohort). There were three significant predictors of LVH: rural Maori (p=0.0001); age (p<0.0001); and gender (p=0.0048). CONCLUSION: Structural and functional heart abnormalities are more prevalent in Maori compared to non-Maori, and especially rural Maori. Early identification should lead to better management, ultimately improving life expectancy and quality of life.
Subject(s)
Hypertrophy, Left Ventricular/ethnology , Native Hawaiian or Other Pacific Islander , Rural Population , Urban Population , Adult , Cohort Studies , Echocardiography , Female , Humans , Hypertrophy, Left Ventricular/diagnosis , Logistic Models , Male , Middle Aged , New Zealand/epidemiology , New Zealand/ethnology , Prevalence , Risk Factors , Socioeconomic FactorsABSTRACT
OBJECTIVES: To document levels of cardiovascular disease (CVD), diagnosed and undiagnosed risk factors and clinical management of CVD risk in rural Maori. METHODS: Participants (aged 20-64 years), of Maori descent and self-report, were randomly sampled to be representative of age and gender profiles of the community. Screening clinics included health questionnaires, fasting blood samples, blood pressure and anthropometric measures. Data were obtained from participants' primary care physicians regarding prior diagnoses and current clinical management. New Zealand Cardiovascular Guidelines were used to identify new diagnoses at screening and Bestpractice electronic-decision support software used to estimate 5-year CVD risk. RESULTS: Mean age of participants (n=252) was 45.7 ± 0.7, 8% reported a history of cardiac disease, 43% were current smokers, 22% had a healthy BMI, 30% were overweight and 48% obese. Hypertension was previously diagnosed in 25%; an additional 22% were hypertensive at screening. Dyslipidaemia was previously diagnosed in 14% and an additional 43% were dyslipidaemic at screening. Type-2 diabetes was previously diagnosed in 11%. Glycaemic control was achieved in only 21% of those with type-2 diabetes. Blood pressure and cholesterol were above recommended targets in more than half of those with diagnosed CVD risk factors. CONCLUSIONS: High levels of diagnosed and undiagnosed CVD risk factors, especially hypertension, dyslipidaemia and diabetes were identified in this rural Maori community. IMPLICATIONS: There is a need for opportunistic screening and intensified management of CVD risk factors in this indigenous population group.
Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Mass Screening , Rural Health/statistics & numerical data , Adult , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Female , Humans , Hyperlipidemias/diagnosis , Hyperlipidemias/epidemiology , Hypertension/diagnosis , Hypertension/epidemiology , Male , Middle Aged , New Zealand/epidemiology , Obesity/diagnosis , Obesity/epidemiology , Prevalence , Risk Factors , Smoking/epidemiologyABSTRACT
OBJECTIVE: To report the processes and protocols that were developed in the design and implementation of the Hauora Manawa Project, a cohort study of heart disease in New Zealand and to report the participation at baseline. METHODS: This study utilised application of a Kaupapa Maori Methodology in gaining tribal and health community engagement, design of the project and random selection of participants from territorial electoral rolls, to obtain three cohorts: rural Maori, urban Maori and urban non-Maori. Logistic regression was used to model response rates. RESULTS: Time invested in gaining tribal and health community engagement assisted in the development and design of clear protocols and processes for the study. Response rates were 57.6%, 48.3% and 57.2%. Co-operation rates (participation among those with whom contact was established) were 74.7%, 66.6% and 71.4%. CONCLUSIONS: Use of electoral rolls enables straightforward sampling but results in low response rates because electors have moved. Co-operation rates highlight the acceptability of this research project to the participants; they indicate the strength of Kaupapa Maori Methodologies in engaging Maori participants and community. IMPLICATIONS: This study provides a model for conducting clinical/biomedical research projects that are compatible with cultural protocols and methodologies, in which the primary aim of the research was Maori health gain.
