Study Raises Red Flag on Rates of Elevated, Abnormal Cholesterol Among American Indian Youth


An analysis of the Strong Heart Family Study details High rates of dyslipidemia in American Indian youth and young adults, with more than 70% of those 15-39 years old affected.

Jessica Reese, PhD | Credit: University of Oklahoma

Jessica Reese, PhD
Credit: University of Oklahoma

A report of data from the Strong Heart Family Study is calling attention to the prevalence of elevated cholesterol levels among American Indian youth and young adults.

Results of the study, which billed as the largest study of cardiovascular health outcomes and risk factors among American Indian adults, found more than 50% of American Indian teens and more than 70% of young adults had dyslipidemia, with the proportion of patients having abnormal cholesterol levels increasing with age and peaking at 78% of those 30-39 years of age. A concerning secondary finding from the study revealed less than 1-in-3 of these patients with primary hypercholesterolemia received medical treatments during the study period.1

“We were surprised about the numbers, especially in adolescents,” said Jessica A. Reese, Ph.D., an epidemiologist in the Center for American Indian Health Research at the University of Oklahoma Health Sciences Center, Oklahoma City.2 “These findings show the importance of early screenings and interventions, especially for teens and young adults who may be more likely to have underlying cardiovascular risks, diabetes, or chronic liver disease.”

Supported by the National Institutes of Health (NIH), the Strong Heart Study was launched in 1988 and is populated with American Indian individuals from 12 communities in tribes in Arizona, Oklahoma, North Dakota, and South Dakota. One of the largest epidemiological studies of American Indians in history, the study included 3 components, with the first assessing cardiovascular disease mortality rates from 1984 to 1994 among tribal members aged 35 to 74 years, the second being a clinical examination of 4549 eligible tribal members, and the third being the morbidity and mortality surveillance of these 4549 participants. Based on the success, a larger family study was born out of the third component in 1997 and was named the Strong Heart Family Study.1,3

From the Strong Heart Family Study, investigators identified 1428 individuals aged 15 to 39 years at baseline examination with lipid measurements at baseline meeting inclusion criteria for their analysis. The study cohort had a median age of 26.8 years, with 25.7% aged 15 to 19 years, 34.7% aged 20 to 29 years, and 39.5% aged 30 to 39 years at baseline.1

Initial analysis revealed 70.6% of the group had dyslipidemia at baseline, with 2.8% recording an LDL-C equal to or greater than 160 mg/dL. Stratification of the cohort revealed the prevalence of dyslipidemia was 55.2%, 73.6%, and 78.0% among individuals aged 15 to 19, 20 to 29, and 30 to 39 years old, respectively. Investigators pointed 11 of the 39 patients with a diagnosis of primary hypercholesterolemia received medical treatments during the study period.1

Further analysis indicated 9.9% had incident plaque, 11.0% had plaque progression, and 9% had incident cardiovascular disease during the follow-up period. Investigators highlighted findings suggesting abnormal cholesterol levels were not only associated with the development of plaque, but also the worsening, with plaque incidence and progression were greater among those with total cholesterol equal to or greater than 200 mg/dL, LDL-C equal to or greater than 160 mg/dL, or non-HDL-C equal to or greater than 130 mg/dL.1

Investigators called attention to multiple limitations within their study to consider when interpreting the findings. These limitations include the generalizability of the results, lack of statistical power to evaluate cardiovascular disease subcategories, reliance on definitions for normal cholesterol levels developed with data from non-Native older adults, and others.1

“This research supports efforts to identify ways, such as increased screenings and culturally relevant education, to improve heart health and support younger generations of Native Americans,” said Mona Puggal, MPH, an epidemiologist in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute, part of NIH.2


  1. Reese JA, Roman MJ, Deen JF, et al. Dyslipidemia in American Indian Adolescents and Young Adults: Strong Heart Family Study. J Am Heart Assoc. Published online March 6, 2024. doi:10.1161/JAHA.123.031741
  2. More than half of American Indian youth may have abnormal or high cholesterol. National Institutes of Health. March 6, 2024. Accessed March 8, 2024.
  3. About. The Strong Heart Study. Accessed March 8, 2024.
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