Cardiovascular disease leading killer among Cherokees
According to this U.S. Centers for Disease Control and Prevention map, for most of the Cherokee Nation’s territory in Oklahoma between 2015 and 2017, cardiovascular disease killed people age 35 and older at a rate of 422 to 1,096 per 100,000 deaths annually. CENTERS FOR DISEASE CONTROL
This American Heart Association graphic gives advice on how to prevent heart disease and stroke. Heart disease is the leading killer among Cherokees, according to a 2016 Cherokee Nation report. AMERICAN HEART ASSOCIATION
TAHLEQUAH – Cherokees and other Native Americans are sometimes vulnerable to health problems not as common in other populations, but they share a leading cause of death with all Americans – cardiovascular disease.
In its 2016 report, Cherokee Nation Public Health split heart disease and stroke into separate causes of mortality – listing them first and fifth, respectively – but because they have common causes, mechanisms and prevention methods, they can be combined as cardiovascular disease.
From 2005-14, cardiovascular disease killed 3,094 Cherokees, making it the tribe’s leading cause of death.
“There are things you can’t control, like family history or genetics,” Dr. David Gahn, medical director for Cherokee Nation Public Health, said. “There aren’t specific genes we can identify to determine risk, but a doctor will ask about family history because heart disease does seem to run in families.”
Other unavoidable factors are age and sex. Heart disease risk is higher in men and older people. Also, black, white and Native Americans are more likely to die of heart disease than Hispanics, Pacific Islanders and Asian Americans.
When diagnosed with cardiovascular disease, there may not be obvious symptoms. Certain conditions will cause doctors to monitor for heart and blood flow problems.
“A combination of factors will lead to conditions,” Gahn said. “High blood pressure, diabetes, obesity, high cholesterol are conditions that need to be monitored and you have to take special care. Some of these conditions are modifiable. Some people can stop smoking and eat a healthy diet and their blood pressure drops back down to normal. Others can get them under control with medicines. People with the conditions should see a doctor routinely.”
A cardiovascular disease diagnosis often follows an episode of heart attack, stroke or chest pains. The most common conditions that result in a diagnosis are coronary artery disease and heart failure. CAD is often found around the heart, but can also be diagnosed in areas that heighten stroke risk, such as the carotid arteries in the neck.
Gahn said those who survive a first heart attack sometimes make a nearly full recovery, with little impact on their physical activities. But many find themselves with limitations in their activities. Heart failure is “particularly devastating,” he said.
“It is difficult to treat,” Gahn said. “The heart can’t pump blood efficiently, and that is a function of the muscle, not the coronary arteries. Heart failure is a chronic condition, but we have medicines to help the heart work more efficiently. It also requires careful diet and fluid management.”
Cardiovascular disease can be treated, and such measures can extend patients’ lives by decades. However, prevention is the most effective “treatment.” Health professionals have told the public how to prevent cardiovascular disease for more than a century.
Paradoxically, studies suggest the message has gotten through and people know how to prevent cardiovascular disease, but many don’t adopt a heart-healthy lifestyle.
“The number one cause of preventable mortality is cigarette smoking,” Gahn said. “If we can help people stop smoking, it makes a huge difference in the quality and length of their lives. The messages are everywhere. ‘Smoking is bad for you. Please don’t do it.’ But people start as kids and nicotine is addictive. We look for ‘food deserts.’ That’s where we in (CN) Public Health can partner with business. How can we help a community to attract businesses that are healthy, or help the businesses that are already there offer healthy food? Unfortunately, the cheapest food is often the least healthy.”
People often claim they don’t have time to exercise, though studies suggest most folks could budget the time.
“Go for a walk. You don’t have to run a marathon,” Gahn said. “You don’t have to spend $1,500 on a high-end bike. Take the dog for a walk. Gardening and chores are exercise. This spring, I talked to patients about birdwatching. I asked them to figure out how many bird songs they could identify and write them down. Plant identification – maybe your grandma told you plants but you’ve forgotten, so get a field guide. That gets you outside. If you have kids in strollers or on tricycles, walking with them is a wonderful way to get exercise.”
Methods to prevent cardiovascular disease may be known, if not always followed, and medical supervision can help people manage dangerous conditions. But the public should be aware of warning signs that a heart attack or stroke is imminent, or that cardiovascular disease has developed.
Many heart attacks are not preceded by symptoms, but those with symptoms can exhibit persistent chest pain; pain in the jaw, neck or back; nausea, dizziness, cold sweat and general weakness; pain in the shoulders or arms; or shortness of breath.
There are other less imminent symptoms that should prompt a medical visit. If, during a span of only a few weeks or months, shortness of breath and rapid heartbeat set in much more quickly with exertion, check with a doctor to find out the cause. A stinging or burning in the chest that starts and stops in lockstep with any exertion is not a good sign, and needs to be examined.
Stroke is even less likely to give advance warning. The acronym to remember – and recommended by the American Stroke Association is FAST. Check the Face for drooping, Arms for weakness, Speech for slurring and – if any of these symptoms are present – it is Time to call 911 or an ambulance.
Other stroke symptoms are numbness, particularly on one side of the body; confusion and difficulty speaking or understanding conversation; vision problems; severe headache with no obvious cause; and dizziness or difficulty walking.
For more information, patients can consult with their primary care physicians or visit cdc.gov