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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

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
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

contributors to the gap
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

driving life expectancy differentials
Driving Life Expectancy Differentials

Source: AIHW Chronic Disease and Associated Risk Factors in Australia, 2006.

risk factor prevalence in australian populations glucose intolerance
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

diabetes mortality australia
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

cardiovascular consequences of dm
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
dm ckd and chd in indigenous australians
DM, CKD and CHD in Indigenous Australians

Wang and Hoy, Kidney Int 2005

Wang and Hoy. MJA 2005

risk of incident cvd in aboriginal people central australia n 739
Risk of Incident CVD in Aboriginal People – Central Australia (n=739)

Rowley, Brown et al

acs co morbidity by ethnicity
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

age adjusted survival and mace free survival acs males
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

cvd risk prediction and dm
CVD RISK PREDICTION AND DM

WANG, ROWLEY, BROWN ET AL 2009

slide17

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
diabetes and heart disease the rumsfeld criteria
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

the known known s cvd and dm
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
known unknowns
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