Heart disease trend alarms doctors

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Hospitalizations for ischemic heart disease in Native people have doubled in the past two decades, while the rate has decreased for others, according to a study published in the June 26 issue of the Archives of Internal Medicine. Toronto doctors who conducted the 17-year Ontario heart study are calling these findings an "alarming trend in Native health," which urgently requires "further research and targeted intervention."

The biggest contributing risk factor for heart disease is diabetes, they say. The rate of diabetes among Native people is currently at least three times higher than for the general population and is believed to be associated with a sedentary lifestyle and high-fat diet.

Dr. Bernard Zinman was one of the heart study's principal researchers, along with doctors Baiju R. Shah and Janet E. Hux . All three are associated with the department of medicine at the University of Toronto and major Toronto teaching hospitals.

Zinman explained that ischemic heart disease is a general term that encompasses all kinds of heart disease resulting from atherosclerosis or hardening of the arteries. Ischemia refers to decreased blood flow to the heart when coronary arteries are blocked.

"What we are shocked to find is that the rates for those Native communities (covered by the study) were much lower in 1980 and 1982 compared to the provincial average, almost half for heart attack rates, but now they've surpassed everybody and are far above the provincial average," Zinman said from Mount Sinai Hospital on July 4.

What's to blame?

"It's almost all diabetes," said Zinman.

He said they examined the health records of 41 communities, 39 of which were in Northern Ontario, that identified a Native population of at least 95 per cent. They found heart disease rates among Native people rose to 186 per 10,000 hospital admissions in 1995 from 76 per 10,000 in 1984.

In the general population in Northern Ontario, the rate decreased from 129 per 10,000 to 110 per 10,000 during the same period.

The rate for all of Ontario currently is 82 per 10,000.

The downward trend among non-Natives is a "common story," Zinman said.

"In the United States and Canada, the rates of heart disease are going down, whereas in this community (Native people) they're going in the opposite direction, and based on other information from other studies, you don't get heart disease if you're a Native unless you have diabetes. It would be very unusual.

"And that is why (Native people) were protected previously," Zinman said. "They almost had lower rates. And so diabetes seems to be the major risk factor for Native people, whereas, Caucasian people-diabetes is a risk factor, so is smoking, so is a bunch of other things.

"So if went into a unit where there were 100 Caucasian people with heart attacks, I would find that about 20 to 25 per cent had diabetes. But if I went into the Native population where there were 100 Native people with heart attacks, I would find that about 80 to 85 per cent had diabetes," Zinman said.

To turn it around, he said a three-pronged intervention is needed.

"One, you've got to try to prevent diabetes," by improving diet and increasing exercise, Zinman said.

"But, that's not enough, because there are lots of people that already have diabetes, so diabetes also has to be treated effectively.

"And the third thing is that people with heart disease must have appropriate access to the good therapies. Just because you have heart disease doesn't mean you are going to die. It means you need, maybe, bypass surgery, you need good drugs, you need effective therapy."

All three are probably deficient in northern communities, Zinman concluded.

Margot Geduld, a spokeswoman for Health Canada in Ottawa, said the government is aware of the study and is "concerned," but Health Canada's programs usually only address factors related to heart disease, such as non-traditional tobacco control and nutrition initiatives to improve diet "in collaboraion and consultation with" Native people.

Whether the study will change the way Health Canada deals with the problem of heart disease in Native communities, Geduld said she's "not sure." She indicated they will likely only change what they pay for if Native communities redefine their own health priorities to the federal government.

Geduld pointed out that Health Canada funded a 28-month diabetes research project undertaken in the Sioux Lookout Zone of northwestern Ontario in 1991. Dr. Zinman and Dr. Stewart Harris, medical director of the zone hospital, spearheaded that work.

Sandy Lake First Nation, with a population of 1,500, was the base for the study that encompassed 30 communities.

Chief Ennis Fiddler of Sandy Lake said following the diabetes study they got some federal funding to hire two people to work on prevention programs that include a radio program.

The workers also have just completed a year-long program to develop an elementary school curriculum in conjunction with the school board in Sandy Lake.

The other thing the community has developed is a walking trail that surrounds their large reserve, as well as programs to encourage its use.

"And recently the program has ordered pedometers that record how many steps you take and how far you walk, the chief said. So far 160 are in use and the workers hope to order more.

Fiddler said it is not as difficult as it once was to get a selection of good food, since it is flown direct from Winnipeg. Food is still "twice as expensive" as it would be in Winnipeg, though, he said.

"I think people are starting to be aware about the diabetes itself and also what they can do to make themselves combat the disease," the chief said. "Ten years ago, people didn't care what they ate . . . all they knew was that today they were okay and they were eating this fat. Today people are starting to think about that. People are making a conscientious effort to make sure they no longer eat that kind of diet." He said foods like heese and vegetables are becoming more popular, but the community still has work to do on getting people to leave their vehicle behind and walk.

Fiddler said he is concerned they still have nothing to offer community members who are already seriously affected by diabetes and whose mobililty may be limited. He said the community has set its sights on getting kidney dialysis set up in Sandy Lake and maybe establishing a nursing home. Currently band members have to move to Sandy Lake or Thunder Bay, 200 and 500 km away, for dialysis.

The chief was aware a study had recently been concluded on heart disease and said the findings would be shared with the community when they got the report.

One of the Sandy Lake diabetes workers, Roderick Fiddler, had also heard of the heart study but had not yet seen it. He said the community was becoming more aware of both diabetes and heart disease and prevention.

He said they have an "ongoing community intervention program" that involves home visits to teach about all aspects of diabetes. Also their hour-long weekly radio programs address different related topics, such as foot care, nutrition and wild game, and eye care.

"I think we're going in the right direction right now," Roderick Fiddler said.