The Strong Heart Study (SHS) is a population-based longitudinal study to investigate cardiovascular disease (CVD) and its risk factors in 13 American Indian communities in 3 geographic areas (Arizona, the Dakotas, and Oklahoma). Data to date show CVD rates in American Indians are now higher than the US average and appear to be increasing. In the SHS Phase I examination, 1,527 eligible tribal members from Oklahoma aged 45 to 74 years were recruited and examined between 1989 and 1991. Phases II and III of SHS were performed in 1993-1995 and in 1997-1999, respectively, to re-examine the original cohort. In Phase III, a highly successful pilot family study was also conducted to demonstrate the feasibility of a genetic study of CVD in American Indians. The Oklahoma center recruited 309 family members of the original cohort from 11 large families to begin the investigation of the genetic determinants of CVD and its risk factors. This application proposes a five-year extension (Phase IV) of SHS to expand the family study and to continue morbidity and mortality surveillance of the original cohort. Each of the 3 field centers will recruit an additional 900 participants who are members of families containing at least 2 SHS cohort members. Furthermore, the pilot study family members will be invited to a follow-up exam after the 900 members are enrolled at each center. The Phase IV family study exams will include cardiac and carotid ultrasound exams, blood pressures, noninvasive measurements of arterial stiffness (tonometry), ECGs, anthropometry, medical history, behavioral assessments (socio-economic status, diet, smoking, alcohol, and physical activity), blood chemistries, lipids, and DNA.
The specific aims of the Phase IV study are to expand the family study to increase the power for genetic analyses, to continue surveillance of the original cohort to ascertain more CVD cases, to investigate the association of some pertinent biomarkers and cardiac functions with the development of CVD, and to initiate mortality surveillance in the family members. The Center for American Indian Health Research at the College of Public Health, University of Oklahoma Health Sciences Center proposes to continue its participation in Phase IV of the study as a Field Center and as the Coordinating Center.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZHL1-CSR-L (M2))
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Fabsitz, Richard
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Weill Medical College of Cornell University
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Oliver-Williams, Clare; Howard, Annie Green; Navas-Acien, Ana et al. (2018) Cadmium body burden, hypertension, and changes in blood pressure over time: results from a prospective cohort study in American Indians. J Am Soc Hypertens 12:426-437.e9
Balakrishnan, Poojitha; Vaidya, Dhananjay; Voruganti, V Saroja et al. (2018) Genetic Variants Related to Cardiometabolic Traits Are Associated to B Cell Function, Insulin Resistance, and Diabetes Among AmeriCan Indians: The Strong Heart Family Study. Front Genet 9:466
Oelsner, Elizabeth C; Balte, Pallavi P; Cassano, Patricia A et al. (2018) Harmonization of Respiratory Data From 9 US Population-Based Cohorts: The NHLBI Pooled Cohorts Study. Am J Epidemiol 187:2265-2278
Spratlen, Miranda J; Grau-Perez, Maria; Best, Lyle G et al. (2018) The Association of Arsenic Exposure and Arsenic Metabolism with the Metabolic Syndrome and its Individual Components: Prospective Evidence from the Strong Heart Family Study. Am J Epidemiol :
Kocarnik, Jonathan M; Richard, Melissa; Graff, Misa et al. (2018) Discovery, fine-mapping, and conditional analyses of genetic variants associated with C-reactive protein in multiethnic populations using the Metabochip in the Population Architecture using Genomics and Epidemiology (PAGE) study. Hum Mol Genet 27:2940-2953
Suchy-Dicey, Astrid M; Muller, Clemma J; Madhyastha, Tara M et al. (2018) Telomere Length and Magnetic Resonance Imaging Findings of Vascular Brain Injury and Central Brain Atrophy: The Strong Heart Study. Am J Epidemiol 187:1231-1239
Spratlen, Miranda J; Grau-Perez, Maria; Umans, Jason G et al. (2018) Arsenic, one carbon metabolism and diabetes-related outcomes in the Strong Heart Family Study. Environ Int 121:728-740
Gong, J; Nishimura, K K; Fernandez-Rhodes, L et al. (2018) Trans-ethnic analysis of metabochip data identifies two new loci associated with BMI. Int J Obes (Lond) 42:384-390
Balakrishnan, Poojitha; Navas-Acien, Ana; Haack, Karin et al. (2018) Arsenic-gene interactions and beta-cell function in the Strong Heart Family Study. Toxicol Appl Pharmacol 348:123-129
de Simone, Giovanni; Wang, Wenyu; Best, Lyle G et al. (2017) Target organ damage and incident type 2 diabetes mellitus: the Strong Heart Study. Cardiovasc Diabetol 16:64

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