title: Cardiometabolic risk and disease in Indigenous Australians: the heart of the heart study.
abstract: OBJECTIVE
  This study assessed the burden and determinants of cardiovascular and metabolic risk in a community sample of high risk Indigenous Australians.
  
  
  BACKGROUND
  Indigenous Australians are over-represented in the most disadvantaged strata of Australian society. The role of psychosocial and socioeconomic factors in patterning cardiometabolic disease in this population is unclear.
  
  
  METHODS
  The Heart of the Heart Study was a cross sectional study of 436 Aboriginal adults from remote, urban and peri-urban communities around Alice Springs (Northern Territory, Australia). Participants underwent detailed assessments of socio-demographic, psychosocial, cardiovascular and metabolic status.
  
  
  RESULTS
  Individuals with depression were twice as likely to have cardiovascular disease (OR 2.03; 1.07-3.88; p<0.05). Chronic kidney disease (39.7%, 37.2% and 18.2%) and diabetes (28.4%, 34.0% and 19.2%) were more common in peri-urban and remote compared to urban communities. Cardiovascular disease did not vary across locations (p=0.069), but coronary artery disease did (p=0.035 for trend). Unemployed individuals were more likely to have cardiovascular disease (OR 2.32; 1.33-4.06; p<0.001). Socioeconomic gradients in coronary artery disease, all cardiovascular disease and diabetes, as measured by income, operated differentially across locations (p for location/socioeconomic status interactions 0.002; 0.01 and 0.04 respectively).
  
  
  CONCLUSIONS
  Participants had high rates of pre-existing cardiovascular disease, diabetes and chronic kidney disease. Cardiovascular risk in these communities was associated with psychosocial factors and socioeconomic indicators. However, gradients operated differentially across location. These data provide a strong foundation for better understanding key drivers of increased levels of cardiovascular and other common forms of non-communicable disease in Indigenous people.
authors.affiliation: Baker IDI Heart and Diabetes Institute, Alice Springs, NT, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia. Electronic address: alex.brown@sahmri.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Brown
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
authors.affiliation: School of Public Health & Preventive Medicine, Monash University, Australia.
authors.forename: Michele
authors.initials: M
authors.lastname: McGrady
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Lee
authors.affiliation: School of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Zeitz
authors.affiliation: School of Public Health & Preventive Medicine, Monash University, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.affiliation: Melbourne School of Population Health, Melbourne University, Melbourne Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Rowley
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology*; D012307:Risk Factors; D055815:Young Adult
keywords: Cardiometabolic; Cardiovascular disease; Depression; Indigenous; Non-communicable disease; Socioeconomic factors