Cardiovascular burden and related risk factors among Nunavik (Quebec) Inuit: Insights from baseline findings in the circumpolar Inuit Health in Transition cohort study

School of Dietetics and Human Nutrition, McGill University, Montreal, Canada.
The Canadian journal of cardiology (Impact Factor: 3.94). 06/2010; 26(6):190-6. DOI: 10.1016/S0828-282X(10)70398-6
Source: PubMed


The Inuit are commonly portrayed to be somehow protected from cardiovascular diseases (CVDs) through their traditional lifestyle and diet. However, actual sociocultural transition and related major, modifiable risk factors have scarcely been quantified in the Inuit population. Such knowledge is extremely valuable in terms of public health intervention.
A total of 887 Inuit residents from Nunavik, Quebec, participated in a cohort study. The estimates presented were derived from anthropometric and biological measurements gathered at the time of recruitment and enhanced by information collected in the medical file of each participant. All estimates were corrected for a complex sampling strategy and bootstrapped to ensure the representativeness of the general Nunavik population.
Overall, 19% of Inuit had a disease of the circulatory system according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Among all disorders, peripheral circulatory system disease was the most prevalent (9%). Prevalences of ischemic heart disease and cerebrovascular disease were of similar magnitude (2.5%). No significant difference in disease prevalence was noted between sexes. The major modifiable CVD risk factors were smoking (84%), obesity (49%) [corrected] (body mass index of greater than 30 kgm2) and elevated blood pressure (13085 mmHg or greater) (18%). Prevalences were globally higher among women.
The current belief that the Inuit are protected from CVD is seriously questioned by the results of the present study. Considering the extremely high prevalence of CVD risk factors, a population-based intervention reinforced for women is urgently needed to reduce their risk.

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    • "How are we?” conducted among the Inuit of Nunavik in 2004. The survey covered all 14 Nunavik communities [6]. In the winter of 2009, participants from the Qanuippitaa Nunavik Health Survey in 2004 were revisited for the additional genetic component. "
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    ABSTRACT: Background Tissue concentrations of fatty acids (FAs) and genetic variations are well-known factors which affect the cardiovascular disease (CVD) risk. The objective was to examine whether the genetic variability of 20 candidate genes and red blood cells (RBCs) percentage of total n-3 polyunsaturated fatty acids (PUFA), a biomarker of dietary n-3 PUFA intake, modulate lipid related CVD risk factors in the Inuit population. Methods Data from the Qanuippitaa Nunavik Health Survey (n = 553) were analysed via multivariate regression models with 40 known polymorphisms, RBCs percentage of n-3 PUFA, and the interaction term to take into account the effect on plasma lipid and apolipoporotein levels. Results Individuals being heterozygotes for CETP C-4502T (rs183130) or G-971A (rs4783961) together with higher n-3 PUFA had lower triacylglycerol (TG) concentrations compared to homozygotes for the minor allele. Further, effects of a stronger beneficial association between n-3 PUFA in RBCs and plasma lipid parameters- including lower total cholesterol (TC), lower low-density lipoprotein cholesterol (LDL-C) or higher high-density lipoprotein cholesterol (HDL-C) concentrations- were associated with AGT M235T (rs699) TT genotype, CETP G-971A (rs4783961) AG genotype, T allele carriers of CETP C-4502T (rs183130), and T allele carriers of CETP Ile405Val (rs5882). In contrast, higher n-3 PUFA in RBCs were associated with adverse lipid profiles- including increased LDL-C, increased apolipoprotein B100 or decreased HDL-C concentrations- in G allele carriers of the APOA5 -3 A/G (rs651821), C allele carriers of APOA5 T-1131C (rs662799), G carriers of APOC3 SstI (rs5128) and G carriers of APOA4 Asn147Ser (rs5104). Conclusion Overall, these results suggest that percentage of total n-3 PUFA of RBCs are associated with lipids related CVD risk factors conferred by genetic variations in the Inuit population.
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    • "Canada 34 46 Á Á Charbonneau-Roberts et al. 2007 (30) Canada 27 68 36 86 Chateau-Degat et al. 2010 (32) Canada 22 22 15 50 Nolin et al. 2007 (38) Canada 29 30 21 55 Dewailly et al. 2007 (11) Canada 26 31 10 71 Liu et al. 2006 (37) Canada Á Á 11 43 Bjerregaard et al. 2002 (39) Greenland 16 22 Á Á Bjerregaard et al. 2010 (9) Greenland 19 25 Á Á Jørgensen 2004 (42) Greenland 18 25 16 58 Jørgensen et al. 2003 (44) Greenland 18 25 16 58 Jørgensen et al. 2004 (45) Greenland 30 32 19 51 Jørgensen et al. 2006 (46) "
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    ABSTRACT: Among circumpolar populations, recent research has documented a significant increase in risk factors which are commonly associated with chronic disease, notably obesity. The present study undertakes a scoping review of research on obesity in the circumpolar Inuit to determine the extent obesity research has been undertaken, how well all subpopulations and geographic areas are represented, the methodologies used and whether they are sufficient in describing risk factors, and the prevalence and health outcomes associated with obesity. Online databases were used to identify papers published 1992-2011, from which we selected 38 publications from Canada, the United States, and Greenland that used obesity as a primary or secondary outcome variable in 30 or more non-pregnant Inuit ("Eskimo") participants aged 2 years or older. The majority of publications (92%) reported cross-sectional studies while 8% examined retrospective cohorts. All but one of the studies collected measured data. Overall 84% of the publications examined obesity in adults. Those examining obesity in children focused on early childhood or adolescence. While most (66%) reported 1 or more anthropometric indices, none incorporated direct measures of adiposity. Evaluated using a customized quality assessment instrument, 26% of studies achieved an "A" quality ranking, while 18 and 39% achieved quality rankings of "B" and "C", respectively. While the quality of studies is generally high, research on obesity among Inuit would benefit from careful selection of methods and reference standards, direct measures of adiposity in adults and children, studies of preadolescent children, and prospective cohort studies linking early childhood exposures with obesity outcomes throughout childhood and adolescence.
    Full-text · Article · Jul 2012
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    • "Although incidence of infectious diseases is still higher than in other western countries, lifestyle-related diseases have now surpassed these (5,6). The lifestyle-related disorders/diseases now abundant in the Arctic regions are: obesity, hypertension, diabetes mellitus Type 2, and cardiovascular diseases (5–10). The change in health epidemiology in Greenland is likely to be due to the social and cultural transition that has occurred in Greenland and other parts of the Arctic region during the past 40–50 years (5,6). "
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    ABSTRACT: The primary objective was to estimate the prevalence of patients diagnosed with hypertension using the proxy marker of antihypertensive drug therapy in Greenland and to compare the prevalences within the 5 health regions in Greenland. The second objective was to review 2 quality indicators in antihypertensive care. Observational and cross-sectional study reviewing electronic medical records. Information about age and gender was collected from all patients receiving antihypertensive drug prescriptions within a 2-year period prior to the data extraction in January 2011. Only patients aged 20 or above were included. The age- and gender-specific prevalence of patients in antihypertensive treatment was calculated using the population as it was 1 January 2010 in Greenland as background population. A subsample consisting of patients in antihypertensive treatment aged 20 or above born within the first 5 days of each month was identified. Review of electronic medical records 1 year back in time (1 January 2010 onwards) was carried out and information on blood pressure obtained. The quality of care was evaluated with respect to 2 indicators: follow-up management and blood pressure level, respectively. The total number of patients in treatment with antihypertensive drugs was 4,462 (1,998 males and 2,464 females) corresponding to a prevalence of 11.4% (4,462/39,231). The prevalence was higher among females than among males. The prevalence increased with age and differed among the 5 health regions. The percentage of patients in antihypertensive treatment with minimum 1 follow-up visit within 1 year (blood pressure measured and registered in a health clinic) was only 77.7%. Some 45% of patients in antihypertensive treatment achieved blood pressure below 140/90 mmHg. Hypertension is a common disorder in Greenland. The quality of antihypertensive care is suboptimal and leaves room for improvement. A national strategy based on guidelines, use of electronic drug prescriptions and recording of blood pressures combined with continuous monitoring the quality is recommended in order to prevent complications of untreated hypertension.
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