Predicting heart disease in Aboriginal and Torres Strait Islander people

This study was a follow-up of cardiovascular disease outcomes for a cohort of Aboriginal people in the Northern Territory who participated in a health screening program (Heart Health) in the 1990s. It aimed to identify what clinical measures best predict the risk of heart attack and stroke in Aboriginal communities in Central Australia.

The first community for whom data collection and analysis was complete was Utopia. The principal finding for this community was that adult mortality rates from all causes during the period 1995-2004 were about 40% lower at Utopia compared to those for Aboriginal people in the NT generally.

Other findings included:

• Death rates from cardiovascular diseases (CVD) run at about half the rate for Aboriginal people in the NT generally.
• Hospitalisation with CVD as the primary cause of admission occurred at a much lower rate for Utopia residents than for other Aboriginal people in the NT.
• Obesity and diabetes occur at lower rates for Utopia residents than for other Aboriginal people in the NT.

It is thought that the benefits of a traditional lifestyle, enabled by the decentralized nature of the community and including regular exercise and intake of bush tucker, is one reason why Utopia residents have achieved these good outcomes, along with lower rates of smoking, strong culture, and the community-directed nature of primary health care services provided by Urapuntja Health Service.

Data collection is complete for other participating communities, and the aggregated dataset is being used to identify the best predictors of cardiovascular disease, so that preventive treatment may be better targeted.

Risk factor surveys were conducted in 1988 and 1995 at Utopia and other communities, and aggregate results reported. Working in collaboration with the community-controlled Urapuntja Health Service and other local services under the terms of written, negotiated project agreements, researchers in this study collected 10-year follow-up data on mortality and hospitalisation from CVD relating to a cohort of about 700 participants in the 1995 surveys. Data for each community has been analysed and reported back in community reports.

Related resources:

• Rowley, K., Anderson, I., O’Dea, K., McDermott, R., Saraswati, K., Tilmouth, R., Roberts, I., Best, J. D., Fitz, J., Jenkins, A., Wang, Z., Wang, Z. & Brown, 2008 ‘A Lower than Expected Morbidity and Mortality for an Australian Aboriginal Population: 10 year follow up in a decentralised community’, Medical Journal of Australia, vol. 188, pp. 283–7.
• O’Neal, D. N., Piers, L. S., Iser, D. M., Rowley, K. G., Jenkins, A. J., Best, J. D. & O’Dea, K. 2008, ‘Australian Aboriginal People and Torres Strait Islanders Have an Atherogenic Lipid Profile that is Characterised by Low HDL-cholesterol Level and Small LDL Particles’, Atherosclerosis, April 6 2008.
• Shemesh, T., Rowley, K. G., Piers, L. S., Best, J. D. & O’Dea, K. 2008, ‘Low High-density Lipoprotein Cholesterol Is the most Prevalent Metabolic Abnormality for Australian Aboriginal People even when Lean’, European Journal of Cardiovascular Prevention and Rehabilitation, vol. 15, pp. 49–51.
• Schutte, A. E., Shemesh, T., Rowley, K. D., Best, J. D., McDermott, R. & O’Dea, K. 2005, ‘The Metabolic Syndrome and Changing Relationship between Blood Pressure and Insulin with Age, as Observed in Aboriginal and Torres Strait Islander Peoples’, Diabetic Medicine, vol. 22, pp. 1589–97. 
• Tilmouth, R., Saraswati, K., Rowley, K. & Brown, A. 2008, ‘Culture, Primary Health Care and Health Outcomes at Utopia Community’, WONCA Asia Pacific Regional conference and RACGP 51st Annual Scientific Convention, Melbourne, October.
• Luke, J. N., Brown, A., O’Neal, D., Kelaher, M., O’Dea, K., Best, J. D., Wang, Z. & Rowley, K. 2008, ‘Lipid Treatment Guidelines and Cardiovascular Risk for Aboriginal People in Central Australia’, NT Chronic Disease Network Conference, Alice Springs.
• Wang, Z., Rowley, K., Wang, Z., O’Dea, K. & Brown, A. 2008, ‘Cardiovascular Disease Risk Prediction for Aboriginal Populations in Central Australia’, Cardiac Society of Australia and New Zealand Conference, Adelaide.
• Rowley, K., Brown, A. D., Saraswati, K., Tilmouth, R., Roberts, I., Fitz, J., Wang, Z., McDermott, R., Anderson, I., Thomas, D. & O’Dea, K. 2006, ‘Outstation Is not a Dirty Word: Lower than expected morbidity and mortality for an Aboriginal population’, The Chronicle, vol. 9(5), p. 5, and presented at the NT Chronic Disease Network Conference, Darwin.
• Good Health Outcomes over Two Decades for a Decentralised NT Aboriginal Community March 2008
• Utopia Lifestyle Halves Mortality March 2008