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The Burden and Contributors to Cardiovascular Disease and Diabetes in Indigenous Australians

The Burden and Contributors to Cardiovascular Disease and Diabetes in Indigenous Australians. Alex Brown Baker IDI. Years of Life Lost (YLL) for the leading disease and injury categories – Indigenous persons 2003. CVD & Diabetes.

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The Burden and Contributors to Cardiovascular Disease and Diabetes in Indigenous Australians

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  1. The Burden and Contributors to Cardiovascular Disease and Diabetes in Indigenous Australians Alex Brown Baker IDI

  2. Years of Life Lost (YLL) for the leading disease and injury categories – Indigenous persons 2003 CVD & Diabetes The Health and Welfare of Australia’s Aboriginal and Torres Strait and Islander Peoples 2008 ABS Catalogue No. 4704.0 AIHW Catalogue No. IHW 21

  3. Contributors to the Gap B/w 1996-2000 NCD - 77% Gap in LE Grp I - 15-16% CVD – 33% GUT – 9% DM – 9% Chronic Resp - 9% Injury – 8% 16.7 years 1996-2000 19.0 years 1996-2000 Zhao and Dempsey, MJA 2006

  4. Driving Life Expectancy Differentials Source: AIHW Chronic Disease and Associated Risk Factors in Australia, 2006.

  5. Risk factor prevalence in Australian populations - glucose intolerance Daniel M, Rowley KG, McDermott R, O’Dea K. Diabetes and impaired glucose tolerance in Aboriginal Australians: prevalence and risk. Diab Res Clin Pract 2002; 57: 23-33. Dunstan D et al. Diabesity and associated disorders in Australia 2000. International Diabetes Institute, Melbourne, 2000

  6. DIABETES MORTALITY -AUSTRALIA Male Death Rates - Diabetes Female Death Rates - Diabetes The Health and Welfare of Australia’s Aboriginal and Torres Strait and Islander Peoples 2008 ABS Catalogue No. 4704.0 . AIHW Catalogue No. IHW 21

  7. Cardiovascular Consequences of DM • Clustered risk factors –MetS, dyslipidaemia, behavioural • CHD - Diffuse /Multi-vessel Disease • Silent Ischaemia • Late diagnosis/recognition • Complications of MI more frequent in DM • CHF • Diabetic Cardiomyopathy • PVD • CVA • Absolute risk equivalent to PMHx of CHD

  8. Impact of DM on CHD Incidence – INTERHEART I

  9. DM, CKD and CHD in Indigenous Australians Wang and Hoy, Kidney Int 2005 Wang and Hoy. MJA 2005

  10. CAD and Diabetes in Aboriginal People

  11. Risk of Incident CVD in Aboriginal People – Central Australia (n=739) Rowley, Brown et al

  12. DM AND CVD IN CENTRAL AUSTRALIA

  13. Baseline Demographics and Clinical Characteristics, CASPA Cohort 2001-2002.

  14. ACS Co-Morbidity by Ethnicity Indigenous (n=235) Non-Indigenous (n=287) 68 149 74 63 64 24 DM DM and CKD DM DM and CKD 29 51 CKD CKD p=0.0001

  15. Age Adjusted Survival and MACE-Free Survival – ACS [Males] Non-Indigenous Indigenous HR = 3.762 [2.15 - 6.58]; p < 0.001 HR = 2.061 [1.40 - 3.02]; p < 0.001

  16. CVD RISK PREDICTION AND DM WANG, ROWLEY, BROWN ET AL 2009

  17. ANS Dysfunction Chronic Stress CNS Mediated Effects Insulin Resistance HPA Activation Obesity SNS Activation Inflammation Adverse Behaviours Negative Emotional States Platelet Activation HPA Dysfunction Endothelial Dysfunction Potential Pathophysiological Pathways linking Chronic Stress, Depression and Atherogenesis. Adapted from Rozanski et al

  18. Depression in Aboriginal men -MHM

  19. INDEPENDANT CORRELATES OF OBESITY IN ABORIGINAL MEN

  20. Diabetes and Heart Disease -The Rumsfeld Criteria “There are known knowns; there are things we know we know. We also know there are known unknowns; that is to say there are some things we know we do not know. But there are also unknown unknowns- the ones we don’t know we don’t know” Fmr US Sec Defence, Donald Rumsfeld

  21. The Known Known's – CVD AND DM • Extremely common • DM is bad for your heart • Independent contributor to CVD in men and women • Independent predictor of adverse CVD outcomes • Commonly co-morbid in Indigenous populations • Accelerated atherogenesis the primary driver of excess death and morbidity in DM • Same treatments are effective in DM • We know what we have to do • We know the system isn’t doing its job

  22. Known Unknowns • How to best deliver what needs to be done • Community based interventions • System level reforms • Reducing the evidence-practice gaps • Access • Incorporating culture as a protective, preventative, management and palliative process • SDIH • Racism/Stress/Marginalisation – biopsychosocial pathways to DM/CVD • Burden of CHF/interplay of DM among Indigenous peoples • How best to engage the family as the unit of intervention • Disadvantage across the life-course

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