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Biomedical subjects

Kurt J Greenlund

Publications and source records attributed to Kurt J Greenlund.

At least 19 recordsLinked to original sources
PubMed2006

Impact of stroke on health-related quality of life in the noninstitutionalized population in the United States.

BACKGROUND AND PURPOSE: Stroke is a major cause of long-term disability in the United States. This study examined the national impact of stroke on health-related quality of life (HRQoL) and disparities in HRQoL across different demographic groups. METHODS: Combined 2000 and 2002 Medical Expenditure Panel Survey data were used, which include quality-of-life measures based on the short-form generic measures (SF-12) and the EuroQol Group measures (EQ-5D index and EQ VAS) for 39,680 adults aged >18 years. Stratified analysis and ordinary least square regressions were used to compare HRQoL scores between stroke and nonstroke populations. RESULTS: The study included 1040 noninstitutionalized stroke survivors. After adjustment for sociodemographics, risk factors, and comorbidities, stroke survivors had statistically significantly lower mean scores for mental health (-4.1%), physical health (-7.9%), health utility (-6.9%), and self-rated health (-7.2%) (all P<0.01). In general, stroke did not affect differences in HRQoL among age or gender groups. However, racial and ethnic disparities in HRQoL were greater among stroke survivors than nonstroke individuals, particularly in health utility scores for black vs white participants (-0.06 in stroke survivors and -0.02 in the nonstroke population, P<0.01) and Hispanic versus non-Hispanic participants (-0.11 in stroke survivors and -0.01 in the nonstroke population). CONCLUSIONS: Stroke significantly impairs HRQoL in the United States. The findings suggest that racial and ethnic disparities in HRQoL among stroke survivors are more pronounced than in the nonstroke population. The burden of nonfatal stroke, especially among racial and ethnic minorities, should be recognized more widely.

Adult↗
PubMed2005

State of disparities in cardiovascular health in the United States.

BACKGROUND: Reducing health disparities remains a major public health challenge in the United States. Having timely access to current data on disparities is important for policy and program development. Accordingly, we assessed the current magnitude of disparities in cardiovascular disease (CVD) and its risk factors in the United States. METHODS AND RESULTS: Using national surveys, we determined CVD and risk factor prevalence and indexes of morbidity, mortality, and overall quality of life in adults > or =18 years of age by race/ethnicity, sex, education level, socioeconomic status, and geographic location. Disparities were common in all risk factors examined. In men, the highest prevalence of obesity (29.2%) was found in Mexican Americans who had completed a high school education. Black women with or without a high school education had a high prevalence of obesity (47.3%). Hypertension prevalence was high among blacks (39.8%) regardless of sex or educational status. Hypercholesterolemia was high among white and Mexican American men and white women in both groups of educational status. Ischemic heart disease and stroke were inversely related to education, income, and poverty status. Hospitalization was greater in men for total heart disease and acute myocardial infarction but greater in women for congestive heart failure and stroke. Among Medicare enrollees, congestive heart failure hospitalization was higher in blacks, Hispanics, and American Indians/Alaska Natives than among whites, and stroke hospitalization was highest in blacks. Hospitalizations for congestive heart failure and stroke were highest in the southeastern United States. Life expectancy remains higher in women than men and higher in whites than blacks by approximately 5 years. CVD mortality at all ages tended to be highest in blacks. CONCLUSIONS: Disparities in CVD and related risk factors remain pervasive. The data presented here can be invaluable for policy development and in the planning, implementation, and evaluation of interventions designed to eliminate health disparities.

Adult↗
PubMed2005

Using behavioral risk factor surveillance data for heart disease and stroke prevention programs.

An effective state heart disease and stroke prevention program must be able to monitor changes in heart disease and stroke risk factors of the state population. The Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey, has been an important source for monitoring health-related factors and evaluating the success of programs. The BRFSS currently includes modules on hypertension and cholesterol screening and awareness, cardiovascular disease preventive practices, and recognition of the signs and symptoms of heart attack and stroke as well as relevant modules on fruit and vegetable intake, physical activity, tobacco use, and diabetes. Publication topics included monitoring risk factors and clinical services, assessing progress toward national goals, assessing health disparities, and health status and health-related quality of life issues. States have used the BRFSS data for monitoring health risks in the state, assessing state and national health objectives, determining and providing data for public health campaigns, providing information for legislative proposals, and providing information that helps to initiate collaboration. Major methodologic issues involve validating self-reported data against direct measurement and assessing the effects of changes in telecommunications. As Centers for Disease Control's (CDC) national heart disease and stroke prevention program and each state health department program develop, state and even local level data will become more important to measure the burden of disease and program impact. State heart disease and stroke prevention programs are encouraged to work closely with state BRFSS coordinators to obtain vital information to measure the burden of heart disease and stroke in their state and to be able to measure program impact on addressing the first and third leading causes of death in the U.S.

Behavioral Risk Factor Surveillance System↗
PubMed2005

Using outcome measures to monitor the performance of the National Heart Disease and Stroke Prevention Program: current capabilities and future challenges.

To determine the success of a state prevention program and to make timely and effective public health decisions, the program's outcomes must be monitored and evaluated. Twenty-one performance measures for the National Heart Disease and Stroke Prevention Program have been developed from the Healthy People 2010 objectives for heart disease and stroke, from performance measures developed in response to the Government Performance and Results Act (GPRA), and from a fiscal year program announcement. We assessed the availability of state surveillance systems that could address these measures. Current state data were available for only six of the 16 Healthy People 2010 objectives, one of the two GPRA performance measures, and for all three of the surveillance-related measures recommended in the program announcements. If states are to meet the Healthy People 2010 objectives related to high blood pressure, cholesterol, and emergency care during a cardiac arrest, new surveillance resources will be required at both the national and state levels. These would include a national surveillance system of state registries of acute cardiac arrest care, as well as state health examination surveys.

Adult↗
PubMed2005

Differences in the prevalence of self-reported risk factors for coronary heart disease among American women by race/ethnicity and age: Behavioral Risk Factor Surveillance System, 2001.

BACKGROUND: Heart disease is the leading cause of death among American women. Data are lacking on the prevalence of specific risk factors among women of various ethnic groups. We examined data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) for prevalence of self-reported risk factors among women by race/ethnicity and age. METHODS: The BRFSS is a state-based, random-digit-dialed telephone survey of the civilian non-institutionalized U.S. population aged > or = 18 years. In 2001, a total of 120,035 women reported whether (1) they had ever been told by a healthcare provider that they had high blood pressure, high cholesterol, or diabetes; (2) they smoked; and (3) they were physically inactive. Obesity status was determined by self-reported height and weight. Data were weighted to each state's population. RESULTS: Among all women, 26.3% had high blood pressure, 23.2% had high cholesterol levels, 21.1% currently smoked, 6.8% had diabetes, 25.4% were obese, and 28.6% physically inactive. Age-adjusted prevalence of high blood pressure was highest among African Americans (AA) (36.3%) and Hawaiian/Pacific Islanders (HPI) (33.7%), and lowest among Asians (18.0%). High blood cholesterol was highest among HPI (23.9%) and white (22.3%) women. American Indian/Alaska Natives (AI/AN) had the highest percentages of diabetes (12.7%) and current smoking (32.4%). Obesity was highest among AA (38.4%) and AI/AN (31.9%) women and lowest among Asian (7.8%) women. Physical inactivity was most common among Hispanic women (42.4%), and least common among Asian women (23.3%). Thirty-eight percent of women had two or more risk factors, ranging from 20.1% of Asian women to 48.8% of AA women. CONCLUSIONS: A substantial proportion of American women have two or more risk factors for heart disease, and the prevalence of individual risk factors varies by racial/ethnic background. Aggressive efforts to reduce and control risk factors, including population-specific programs, are crucial for limiting the incidence of heart disease.

Adolescent↗
PubMed2005

Major coronary risk factors and death from coronary heart disease: baseline and follow-up mortality data from the Second National Health and Nutrition Examination Survey (NHANES II).

BACKGROUND: Although the major risk factors for coronary heart disease (CHD) are well-established, intense efforts persist in the search for "novel" or "emerging" risk factors because of the notion that as many as half of CHD victims may not have the traditional risk factors. OBJECTIVE: Compare prevalences of major risk factors among persons with fatal CHD in a nationally representative population sample. METHODS: Baseline data from the Second National Health and Nutrition Examination Survey and 17-year follow-up mortality data were examined for 8,069 adults (3,701 men; 4,368 women) aged 30 to 75 years in 1976-1980. We calculated sex-specific prevalences of hypertension, elevated total cholesterol (> or = 240 mg/dL), cigarette smoking, and the presence of at least one of these three major risk factors. The relative risk of death from CHD associated with the three major risk factors was calculated in sex-specific multivariable models adjusted for age, race, and education. RESULTS: Overall, nearly 75% of US adults had at least one of the three major risk factors. Those who died of CHD, compared to those who did not die of CHD, had respectively, greater prevalences of hypertension (men: 48% vs. 38%; women: 76% vs. 33%). Similarly, persons who had fatal CHD were more likely to have elevated total cholesterol (men: 53% vs. 30%; women: 55% vs. 34%), although the finding was not statistically significant in women. Smoking prevalence was also greater among persons who died of CHD than those who did not for both men (64% vs. 40%) and women (43% vs. 33%). The proportion of persons with at least one of the three major risk factors was significantly (P < or = 0.01) greater among those who died from CHD compared with those who did not (men: 92% vs. 74%; women: 98% vs. 70%). The risk of fatal CHD was 51% lower among men and 71% lower among women with none of the 3 risk factors compared to those with at least one. Had all three major risk factors not occurred, 64% of all CHD deaths among women and 45% of all CHD deaths among men could have been avoided. CONCLUSIONS: Nine out of ten US adults who died of CHD had at least one of the three major established risk factors. Thus, the notion that many CHD victims do not have the traditional risk factors is a misconception. Policies and strategies that increase the prevalence of a low risk profile are needed, and aggressive efforts in the prevention and control of the major established risk factors remain the key to continued reductions in CHD mortality.

Adult↗
PubMed2005

Racial differences in the use of aspirin: an important tool for preventing heart disease and stroke.

BACKGROUND: Regular aspirin use, particularly as secondary prevention, reduces morbidity from heart disease and stroke. Few studies have examined racial/ethnic differences in aspirin use for the prevention of cardiovascular disease (CVD). METHODS: Data from the 2001 Behavioral Risk Factor Surveillance System (n=2,514 African Americans; n=865 Hispanics; n=28,038 Whites) were used to assess racial/ethnic differences in aspirin use. Multivariable logistic regression was used to examine whether the likelihood of aspirin use differs by race/ethnicity after accounting for sociodemographic and CVD risk factors. RESULTS: Regular aspirin use was associated with increasing age, male gender, lower educational attainment, hypertension, diabetes, overweight, and histories of myocardial infarction, coronary heart disease, and stroke. Aspirin use was lower among African Americans and Hispanics than Whites (28.6% and 28.7% vs 37.1%, respectively). After adjustment for sociodemographic and CVD risk factors, African Americans and Hispanics were 30%-40% less likely than Whites (OR=0.6, 95% C1=0.5, 0.7, African Americans; OR=0.7, 95% CI=0.5, 1.0, Hispanics) to take aspirin. Although aspirin use was higher among those with CVD (73.6% African Americans, 73.6% Hispanics, and 82.7% Whites), after multivariable adjustment, African Americans and Hispanics with CVD remained 30% to 50% less likely to use aspirin than Whites (OR=0.7, 95% CI=0.4, 1.2, African Americans; OR=0.5, 95% CI=0.2, 1.1, Hispanics). CONCLUSIONS: African Americans and Hispanics are less likely to take aspirin than their White counterparts. Differences in sociodemographic characteristics and CVD risk factors do not account for lower aspirin use among racial/ethnic minorities. Additional studies should examine methods to increase aspirin use in these populations.

Adult↗
PubMed2004

Prevalence of heart disease and stroke risk factors in persons with prehypertension in the United States, 1999-2000.

BACKGROUND: Recent guidelines classify persons with above-optimal blood pressure (BP) but not clinical hypertension as having prehypertension. METHODS: Data were analyzed for 3488 persons aged 20 years and older with BP measured in the 1999-2000 National Health and Nutrition Examination Survey. The prevalence of risk factors-above-normal (> or =200 mg/dL [> or =5.17 mmol/L]) and high (> or =240 mg/dL [> or =6.21 mmol/L]) total cholesterol levels, diabetes mellitus, current smoker, and overweight or obesity-and the number of risk factors present were compared among BP groups (normotension, prehypertension, and hypertension). Multivariable logistic regression included age, sex, and race/ethnicity as covariates. RESULTS: Overall, 39% of persons were normotensive,31% were prehypertensive, and 29% were hypertensive. The age-adjusted prevalence of prehypertension was greater in men (39.0%) than in women (23.1%). African Americans aged 20 to 39 years had a higher prevalence of prehypertension (37.4%) than whites (32.2%) and Mexican Americans (30.9%), but their prevalence was lower at older ages because of a higher prevalence of hypertension. The probabilities of above-normal cholesterol levels, overweight/obesity, and diabetes mellitus were greater for persons with prehypertension vs normotension, whereas the probability of currently smoking was lower. Persons with prehypertension were 1.65 times more likely to have at least 1 other adverse risk factor than were those with normotension (P<.001). Among participants with prehypertension, there were no significant race/ethnic or sex differences in the likelihood of having at least 1 other risk factor. CONCLUSIONS: The greater prevalence of risk factors in persons with prehypertension vs normotension suggests the continued need for early clinical detection and intervention of prehypertension and comprehensive preventive and public health efforts.

Adult↗
PubMed2004

Racial and ethnic disparities in cardiovascular risk factors among stroke survivors: United States 1999 to 2001.

BACKGROUND AND PURPOSE: Stroke mortality is higher among US blacks than it is among US whites. Few studies have examined racial and ethnic differences in the prevalence of cardiovascular disease (CVD) risk factors among stroke survivors, especially among Hispanics. METHODS: Data are from 96 501 persons aged 18 years or older who participated in the 1999, 2000, or 2001 National Health Interview Survey, a continuous annual household-based survey of the US population. Participants reported a history of stroke, hypertension, diabetes, myocardial infarction, and coronary heart disease. Other CVD risk factors were current smoking, overweight/obese, inadequate physical activity, and binge drinking. RESULTS: Stroke was reported by 2.8% of blacks, 1.3% of Hispanics, and 2.2% of whites. Among 2265 stroke survivors, blacks were 1.65-times more likely (95% CI, 1.55 to 1.75) and Hispanics were 0.73-times less likely (95% CI, 0.69 to 0.78) than whites to report hypertension. Hispanics and blacks were more likely than whites to report diabetes (P<0.05). Hispanics and blacks were less likely than whites to report total coronary heart disease (P<0.05). Overweight was 1.63-times higher among blacks (95% CI, 1.55 to 1.73) and 1.36-times higher (95% CI, 1.30 to 1.44) among Hispanics than whites. Blacks were 1.82-times more likely (95% CI, 1.71 to 1.94) and Hispanics 2.09-times more likely (95% CI, 1.98 to 2.22) than whites to report inadequate levels of physical activity. Binge drinking and smoking were less common among Hispanics and Blacks than among whites (P<0.05). CONCLUSIONS: Racial and ethnic disparities exist in stroke prevalence and CVD risk behaviors and medical history. Targeted secondary prevention will be important in reducing disparities among Hispanic and black stroke survivors.

Adult↗
PubMed2004

Trends in self-reported multiple cardiovascular disease risk factors among adults in the United States, 1991-1999.

BACKGROUND: There are few national- and state-level data on multiple cardiovascular disease (CVD) risk factor status and trends over time. We examined the prevalence of self-reported multiple CVD risk factors from 1991 through 1999. METHODS: The Behavioral Risk Factor Surveillance System is a state-based telephone survey of adults 18 years or older. Surveys in 1991, 1993, 1995, 1997, and 1999 ascertained reported high blood pressure, high blood cholesterol level, diabetes, obesity, and current smoking status. Trends in the prevalence of persons with each risk factor and of having 2 or more risk factors were calculated. Data were age standardized to the 2000 US population. RESULTS: From 1991 to 1999, the prevalence of reported high blood pressure increased from 23.8% to 25.4%, high cholesterol levels increased from 24.9% to 27.7%, diabetes increased from 5.5% to 7.1%, obesity increased from 13.5% to 20.3%, and smoking remained at approximately 21%. The prevalence of adults with 2 or more risk factors increased from 23.6% in 1991 to 27.9% in 1999 and significantly increased for both men and women and for all race or ethnic, age, and education groups. Among states, the prevalence of multiple risk factors ranged from 15.0% to 29.9% in 1991 and from 18.7% to 37.1% in 1999. From 1991 to 1999, the prevalence of multiple risk factors increased by 10% or more in 36 states. CONCLUSIONS: The substantial proportion of persons with known multiple risk factors (25% of the population) suggests that increased CVD prevention and risk factor reduction efforts should focus on comprehensive risk reduction strategies.

Adolescent↗
PubMed2004

Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001.

BACKGROUND: Timely access to emergency cardiac care and survival is partly dependent on early recognition of heart attack symptoms and immediate action by calling emergency services. We assessed public recognition of major heart attack symptoms and knowledge to call 9-1-1 for an acute event. METHODS: Data are from the 2001 Behavioral Risk Factor Surveillance System, a state-based telephone survey. Participants (n = 61,018) in 17 states and the U.S. Virgin Islands indicated whether the following were heart attack symptoms: pain or discomfort in the jaw, neck, back; feeling weak, lightheaded, faint; chest pain or discomfort; sudden trouble seeing in 1 or both eyes (false symptom); pain or discomfort in the arms or shoulder; shortness of breath. Participants also indicated their first action if someone was having a heart attack. RESULTS: Most persons (95%) recognized chest pain as a heart attack symptom. However, only 11% correctly classified all symptoms and knew to call 9-1-1 when someone was having a heart attack. Symptom recognition and the need to call 9-1-1 was lower among men than women, persons of various ethnic groups than whites, younger and older persons than middle-aged persons, and persons with less education. Persons with high blood pressure, high cholesterol, diabetes mellitus, or prior heart attack or stroke were not appreciably more likely to recognize heart attack symptoms than were persons without these conditions. CONCLUSIONS: Public health efforts are needed to increase recognition of the major heart attack symptoms in both the general public and groups at high risk for an acute event.

Adult↗
PubMed2004

Characteristics of people aged 45 years or older with heart disease by frequent mental distress status, 2001.

BACKGROUND: Depression commonly occurs after nonfatal cardiac events and is associated with adverse health outcomes. METHODS: In 2001, the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized adults, administered cardiovascular health questions to 19 states and DC. Among those aged > or = 45 years, we examined the association of frequent mental distress (FMD) (> or = 14 self-reported mentally unhealthy days in the past 30 days) with modifiable adverse behaviors (smoking, physical inactivity, and obesity) and health care coverage. RESULTS: The prevalence of FMD among adults with heart disease was 14.8%. Age-adjusted odds ratios indicated that adults with heart disease and FMD were more likely to smoke, to be physically inactive, to be obese, and to be without health care coverage than persons without FMD. Although frequent mental distress was associated with only one adverse health behavior (physical inactivity) after fully adjusting when these health behaviors were considered separately, we observed a twofold increased likelihood for the presence of multiple adverse health behaviors among those with FMD as compared to those without FMD. CONCLUSIONS: Medical counseling on lifestyle changes after cardiac events is accepted as a key part of rehabilitation; however, the mental well-being of patients may also need to be monitored, as it may be a mediating factor in achieving healthy lifestyle goals.

Aged↗
PubMed2004

Increases in job strain are associated with incident hypertension in the CARDIA Study.

BACKGROUND: Job strain, defined as high job demands and low decision latitude, has been associated with increased blood pressure levels in some studies, but most of these studies have been cross-sectional. PURPOSE: We sought to determine whether changes in job strain during young adulthood were associated with the development of hypertension, using the Coronary Artery Risk Development in Young Adults cohort. METHODS: A total of 3,200 employed, initially normotensive participants, aged 20 to 32 in 1987-1988, were followed for 8 years; the Job Content Questionnaire was completed twice: initially and 8 years later. Hypertension at follow-up was defined as systolic blood pressure (SBP) of 160 or higher and diastolic blood pressure of 95 mmHg or higher, or reporting being on antihypertensive medication. RESULTS: Job strain (based on job demands above the median and decision latitude below the median of the sample) was associated with hypertension incidence (ps <.05) for the entire cohort and among White women and men. Adjustment for baseline SBP, education, body mass index (BMI), change in BMI, and age did not alter these relations. The ratio of increasing demands relative to decreasing decision latitude was also associated with greater incidence of hypertension in the entire cohort in the multivariate model (odds ratio = 2.06, 95% confidence interval = 1.01-4.26). CONCLUSIONS: An increase in job strain is associated with incident hypertension, particularly among Whites.

Adult↗
PubMed2003

Low public recognition of major stroke symptoms.

BACKGROUND: A Healthy People 2010 objective includes increasing public awareness of the warning signs of stroke, yet few data exist about the level of awareness. Recognition of stroke symptoms and awareness of the need to call 911 for acute stroke events were examined among the general population. METHODS: Data are from 61,019 adults participating in the 2001 Behavioral Risk Factor Surveillance System, a state-based telephone survey. Respondents indicated whether the following were symptoms of stroke: confusion/trouble speaking; numbness/weakness of face, arm, or leg; trouble seeing; chest pain (false symptom); trouble walking, dizziness, or loss of balance; and severe headache with no known cause. Persons also reported the first action they would take if they thought someone was having a stroke. RESULTS: Only 17.2% of respondents overall (5.9% to 21.7% by state) correctly classified all stroke symptoms and indicated that they would call 911 if they thought someone was having a stroke. Recognition of all symptoms and knowledge of when to call 911 were comparable by gender but lower among ethnic minorities, younger and older people, those with less education, and current smokers compared to whites, middle-aged people, those with more education, and nonsmokers, respectively. There were no substantive differences by history of hypertension, diabetes, heart disease, or stroke. CONCLUSIONS: Public recognition of major stroke symptoms is low. Educational campaigns to increase awareness among the general population and targeted messages to those at high-risk persons and their families may help to improve time to treatment for adults suffering acute strokes.

Adult↗
PubMed2003

Public health surveillance for disease prevention: lessons from the behavioral risk factor surveillance system.

The burden of chronic diseases is increasing worldwide. Surveillance of behavioral risk factors is a crucial element for prevention and control of chronic diseases. Adequate surveillance data will provide the basis for developing and implementing appropriate preventive programs at the local and country level. A standardized surveillance system worldwide will allow data comparability, and will decrease the cost of the surveillance system. By using lessons from the Behavioral Risk Factor Surveillance System, a large, ongoing, state-based surveillance system in the United States, countries may save limited resources, and expedite the initiation of their own surveillance systems. To prevent cardiovascular diseases worldwide, it is time to develop and implement appropriate surveillance systems at a country level, in order to track risk factors. This strategy will provide the basis for developing intervention programs designed to reduce, or prevent a further increase in, the burden of chronic diseases.

Behavioral Risk Factor Surveillance System↗
PubMed2003

Increasing trends in pre-transport stroke deaths--United States, 1990-1998.

OBJECTIVE: We examined national trends in places where stroke deaths occurred. METHODS: National vital statistics data (1990-1998) for stroke death (ICD-9 codes 430-438) were analyzed for place of death by selected socio-demographic characteristics and stroke subtype. RESULTS: Half of all stroke deaths in 1998 occurred in-hospital, 46.1% occurred pre-transport, 0.6% were dead on arrival, and 3.3% occurred in the emergency department. Pre-transport deaths accounted for 55.0% of ischemic strokes, 12.8% of intracerebral strokes, and 12.9% of subarachnoid hemorrhagic strokes. The proportions of stroke deaths occurring pre-transport increased from 1990 through 1998 by 22.9% for all strokes, by 25.3% for ischemic, and by 24.3% for hemorrhagic stroke deaths. CONCLUSIONS: Almost half of stroke deaths occur prior to hospital admission. Research must identify factors that promote more timely access to effective medical care. Further efforts are needed to increase public awareness about stroke symptoms in order to reduce both delays in seeking treatment, and untimely deaths from stroke.

Adolescent↗
PubMed2002

Association of the insulin resistance syndrome and microalbuminuria among nondiabetic native Americans. The Inter-Tribal Heart Project.

This study investigated the association between microalbuminuria and the insulin resistance syndrome (IRS) among nondiabetic Native Americans. In a cross-sectional survey, age-stratified random samples were drawn from the Indian Health Service clinic lists for one Menominee and two Chippewa reservations. Information was collected from physical examinations, personal interviews, and blood and urine samples. The urinary albumin:creatinine ratio (ACR) was measured using a random spot urine sample. The IRS was defined by the number of composite traits: hypertension, impaired fasting glucose (IFG), high fasting insulin, low HDL cholesterol, and hypertriglyceridemia. Among the 934 eligible nondiabetic participants, 15.2% exhibited microalbuminuria. The prevalence of one, two, and three or more traits was 27.0, 16.6, and 7.4%, respectively. After controlling for age, sex, smoking, body mass index, education, and family histories of diabetes and kidney disease, the odds ratio (OR) for microalbuminuria was 1.8 (95% confidence interval [CI], 1.1 to 2.8) for one IRS trait, 1.8 (95% CI, 1.0 to 3.2) for two traits, and 2.3 (95% CI, 1.1 to 4.9) for three or more traits (versus no traits). The pattern of association appeared weaker among women compared with men. Of the individual IRS traits, only hypertension and IFG were associated with microalbuminuria. Among these nondiabetic Native Americans, the IRS was associated with a twofold increased prevalence of microalbuminuria. Health promotion efforts should focus on lowering the prevalence of hypertension, as well as glucose intolerance and obesity, in this population at high risk for renal and cardiovascular disease.

Adult↗