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UBC Theses and Dissertations

Indigenous cardiovascular health : assessing disease, risk factors, and patient care McCallum, Rylan Kevin


Background: Indigenous Peoples are extremely diverse and have unique cultural and social histories that have allowed them to remain resilient through decades of colonialism aimed to disrupt the health of their communities. Chronic diseases, including cancer, diabetes, and atherosclerotic cardiovascular disease (ASCVD) are leading causes of morbidity and mortality and disproportionately impacts Indigenous populations. In high income countries, such as Canada, Indigenous populations experience ASCVD rates 1.5 to 2.5 times higher than their non-Indigenous counterparts. There are several factors which contribute to this disproportionate burden of ASCVD, including systematic racism and discrimination in healthcare, however, social determinants of health, such as these, are often overlooked when designing and implementing healthcare strategies in the current western-based medical system. Methods: To generate background knowledge, we conducted a comprehensive narrative review examining existing studies and grey literature on the prevalence of ASCVD in Indigenous populations in Canada and discuss recommendations for future addressment strategies (Chapter 1). To understand major risk factors for ASCVD, we conducted a systematic review and meta-analysis estimating the prevalence of hypercholesterolemia in Indigenous populations (Chapter 2). Addressing the need to understand how Indigenous patients view equitable cardiovascular care, we conducted a prospective observational study assessing the cardiovascular care of Indigenous patients with premature ASCVD (Chapter 3). Results: Our findings reveal significantly higher rates of ASCVD in Indigenous populations compared to non-Indigenous populations. While hypercholesterolemia and familial hypercholesterolemia, significant risk factors for ASCVD, were found to be inadequately studied in Indigenous populations, we estimated the pooled-prevalence of hypercholesterolemia to be 28.9%, demonstrating it is extremely common in Indigenous populations. To address ASCVD, Indigenous populations should be provided access to evidence-based cardiovascular care which we found increases medication uptake and significantly improves lipid profiles, decreasing risk of recurrent cardiovascular events for Indigenous patients. Conclusion: Indigenous populations are significantly impacted by ASCVD and major risk factors, including hypercholesterolemia. We recommend the establishment of collaborative alliances with Indigenous communities to augment the accessibility of screening and testing services, thereby enhancing Indigenous Peoples' awareness of ASCVD, and major associated risk factors, and affording them the autonomy to participate in screening initiatives at their discretion.

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