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NHLBI Obesity Research

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The Strong Heart Study (SHS)

Project Period: 10/1/1988–5/31/2018
Contact: Ms. Mona Puggal

The Strong Heart Studyexternal disclaimer (SHS) is a study of cardiovascular disease and its risk factors among American Indian men and women supported by the National Heart, Lung, and Blood Institute (NHLBI) since October 1, 1988 and is the largest epidemiologic study of American Indians ever undertaken. The SHS, which uses standardized methodology, is designed to estimate cardiovascular disease mortality and morbidity and the prevalence of known and suspected cardiovascular disease risk factors in American Indians and to assess the significance of these risk factors in a longitudinal analysis.

The study included 13 American Indian tribes and communities in three geographic areas: an area near Phoenix, Arizona, the southwestern area of Oklahoma, and western and central North and South Dakota. In its initial stages, the SHS included three components. The first was a survey to determine cardiovascular disease mortality rates from 1984 to 1994 among tribal members aged 35-74 years of age residing in the 3 study areas (the community mortality study). The second was the clinical examination of 4,549 eligible tribal members. The third component is the morbidity and mortality (M&M) surveillance of these 4,549 participants. The SHS has completed three clinical examinations of the original Cohort (Phase I: 1989-1991; Phase II: 1993-1995; Phase III: 1998-1999, respectively).

Due to the importance of genetics in the occurrence of CVD, the SHS expanded into the genetic epidemiology area. In the Phase III study, in addition to the original Cohort examination, the study conducted a pilot family study. Each field center recruited about 10 large families. The family pilot study recruited approximately 30 families which consisted of more than 900 family members. Due to the success of the pilot study, Phase IV was funded to conduct a full-scale family study to investigate the heritability of CVD and its risk factors and to localize genes that contribute to CVD risk. A 10-centimorgan map was constructed and linkage analysis was performed to assess the heritability of CVD risk factors. In Phase IV, an additional 18 to 25 extended families (a total of about 900 members at least 15 years of age) were recruited from each of the field centers from 2001-2003. This provides a total of 3,776 individuals from 94 families, of whom 825 are Phase III participants re-examined in Phase IV. Phase V completed the second exam on over 90% of the living family cohort and continued surveillance of the original cohort. Follow-up of linkage findings continues with fine mapping and candidate gene genotyping. A competing continuation application for Phase VI is planned.

Last Updated April 2015

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